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June 22, 2020

How AdventHealth revamped clinician onboarding amid Covid-19—without delaying start dates

Daily Briefing

    By Lauren Rewers and Taylor Hurst

    For many organizations, summer brings large cohorts of new hires, many of them freshly graduated from clinical programs. But given restrictions on in-person meetings, this year's onboarding process will look quite different. Rather than delay start dates, many organizations opted to create virtual orientation programs from scratch—and retooled their approach to necessary in-person trainings to protect staff safety.

    The medical leader's guide to onboarding newly hired physicians

    To learn how one organization launched its virtual onboarding program, we spoke to Annette Carter, the regional director of learning within AdventHealth's Central Florida Division. Read on to see her lessons learned from the experience, and an early perspective on how the region will onboard its summer cohort of new graduate nurses.

    AdventHealth's pivot to virtual onboarding

    AdventHealth's traditional new hire onboarding runs for one week, and is split into three sections: two days for required HR training; one day for a clinical overview on topics such as safety and infection control; and two days with Cerner representatives to train employees on AdventHealth's EHR.

    When Florida tightened restrictions on meeting size in March, leaders quickly shifted their onboarding to be almost entirely virtual—without delaying any start dates. Carter said they were able to quickly pivot by adhering to three key principles:

    • Start simple, and iterate on trainings over time. For the first virtual orientation, AdventHealth created modules within their learning management system that covered the topics they would usually present live. The combined content equaled approximately the same amount of time spent in orientation. New hires were allowed to complete these modules at their leisure during their designated onboarding period.

      But over consecutive start dates, these teams were able to iterate to improve the new hire experience. For example, educators reached out to new hires in advance of their start date to create a more personal connection. Leaders overseeing the clinical orientation opted to swap some of their recorded modules with live, virtual presentations.

      Over time, the group also switched up the schedule to reflect feedback from new hires. At first, leaders scheduled live sessions at the beginning and end of the day, with a mid-day break to complete modules. After the first few orientations, they moved all live presentations to the morning and left the afternoon free to complete modules.

    • Keep it modular so you can adapt quickly. Each department was responsible for its portion of the orientation week, allowing AdventHealth to spread work throughout the team and modify trainings in the way that made the most sense over time. The teams drew inspiration from one another's work but weren't mandated to standardize trainings or communication.

      For example, HR developed a letter to send to new hires in advance of onboarding with instructions of how to access training modules, which all teams eventually adopted. Carter noted that while it means new hires receive multiple welcome letters from different teams, keeping the program modular allows them to update their individual trainings without having to consistently revisit and rewrite a single welcome letter. 

      See AdventHealth's Clinical Orientation welcome letter

    • Adjust unit orientation to account for training unable to translate virtually. For example, Carter and her team realized that they could no longer certify new clinicians in group settings for hands-on skills. Instead, they adjusted preceptor competencies and responsibilities to ensure preceptors certified oncoming clinicians in these skills during the first week on the unit.

      The initial feedback on the new virtual onboarding process has been overwhelmingly positive, Carter said. But she notes that the true measure of success will be the end-of-year turnover rates for this cohort, which she plans to examine in early 2021.

    Preparing for the new graduate RN summer cohort

    Virtual onboarding isn't the only way AdventHealth adjusted its new hire onboarding process. It also readjusted sessions that could not be translated virtually to reduce the risk of staff infection.

    For example, the system is tentatively planning to continue live simulation-based training for its summer cohort of 55 new graduate nurses, rather than attempt to offer a virtual alternative—because Carter believes that the direct sensory experience is crucial to learning. Instead, the organization will offer a greater number of simulation days so they can reduce the number of new hires in each session.

    Similarly, their nursing education team will plan to decentralize some aspects of the weekly nurse residency touchpoints. Though typically all new graduate nurses from across the system would attend these meetings together to foster a sense of community, each campus educator will instead be responsible for leading these meetings for his or her organization's new graduates. The team will also include any new graduate nurses who joined the organization since January, so they are able to form connections with their peers.

    Planning for summer onboarding?

    Amid so much uncertainty, transition to practice will be more challenging than ever this year for new clinicians. We'll be here to share insights and lessons learned from your peers across the country. If you would like to share your experiences with our research team, contact me directly at

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