Almost all health care organizations need to re-focus retaining first-year staff for two primary reasons.

First, new hire turnover is costly. Unexpected turnover creates extra work for managers, remaining staff, and the HR team. More importantly, when new hires you haven’t yet recouped your investment on hiring and training them.

Second, new hire separations make up a growing share of all turnover in health care. Nearly one in three staff who left had less than one year of tenure.

This research briefing offers eight insights to strengthen your first-year staff retention strategy beyond traditional onboarding and orientation programs.

There is a clear link between engagement and loyalty: engaged staff generally agree they plan to stay at their organization, while disengaged staff typically disagree they will stay. In other words, for most staff, there’s very little gap between a staff member’s engagement level and their loyalty level. However, we see this relationship between engagement and loyalty break down for staff under the age of 35 with less than three years of tenure.

Some staff leave within their first year because they weren’t the right fit for your organization to begin with. If you’re seeing a spike in first-year turnover, especially in the first 90 days, take a close look at your hiring practices.

When staff leave unexpectedly, it can take hiring teams weeks—if not months—to fill vacancies. That delay leaves teams with a heavier workload, which can lead to more turnover.

Frontline managers are your first line of defense for retaining staff. Yet, in our conversations with managers, many of them are hesitant to ask staff directly if they plan to leave.

New hires often worry about whether they are meeting the expectations of their role. If they’re not sure, they may start feeling they aren’t a good fit for the job—and ultimately leave. Since managers expect new hires to go through a learning curve, they often don’t realize that their new hire may be feeling unsuccessful.

Managers alone don’t make or break the new hire experience. In most cases, new hires spend more time with their peers than they spend with their manager. The relationship a new hire has with their team can play a critical role in whether they choose to leave or stay.

It’s not news that tenured staff can make new hires feel they aren’t welcome or supported. Most organizations can spot and weed out active bullies. However, it’s not just these extreme cases that can negatively impact a new hire’s experience. More often than not, it’s peers’ more subtle behaviors that make new hires feel their teams don’t support them. But it’s challenging to detect this type of incivility.

If you could predict which team members are thinking about leaving, you could intervene and perhaps change their mind. The challenge, of course, is figuring out which staff might have one foot out the door.