Across the United States, approximately one-third of newly licensed registered nurses leave their jobs within their first two years, and turnover rates reach as high as 56% by the second year. The cost of that loss is more than financial; it strains recruitment, disrupts patient care, breaks unit cohesion, and fuels the ongoing nursing shortage.
Julie Miller
Clinical Practice Specialist, American Association of Critical-Care Nurses
“When I was a new grad in the ICU, I found orientation challenging, especially keeping track of the binder with endless paperwork. When I first looked through my incremental goals and unit checklist, I thought there was no way we could get through all of it. It added a lot of anxiety on top of the stress of being a new nurse to practice,” said nurse educator Sara Grieshop.
The transition into high‑acuity environments, such as intensive care units, is particularly challenging. According to studies, up to 1 in 4 new critical care nurses leave their job within the first year, due in part to inadequate onboarding and emotional exhaustion.
For hospitals, replacing a clinical nurse typically costs $50,000 to $64,000, and the average U.S. hospital loses between $4.4 million and $6.9 million annually due to turnover.
The long-term benefits of thoughtful onboarding
The New Nurse Orientation Pathway, developed by the American Association of Critical-Care Nurses (AACN), was designed to address these gaps with a combination of objective knowledge assessment, individualized education, and a structured framework that supports preceptor coaching. Research shows that formal, evidence-based onboarding programs can reduce new-hire turnover by up to 25% and significantly improve job satisfaction and competence metrics.
“I truly believe I am the ICU nurse I am today because of the structured, thoughtful onboarding I received when I transitioned into critical care. After being on a neurology-telemetry floor for 1.5 years as a new grad, transitioning to critical care felt like a big leap, but I felt supported every step of the way,” said Maddi Ward, a critical care nurse and industry influencer.
Structured onboarding means more than boxes to check in a binder; it’s a shared compass. When new nurses understand their starting point and receive education tailored to their needs, they move from merely surviving to thriving. It reflects the kind of environment AACN’s Healthy Work Environment Standards call for: one where appropriate staffing, meaningful recognition, and authentic leadership create the conditions for new nurses to learn, question, and grow.
“To me, a healthy work environment means being able to say, ‘I made a mistake’ without fear of retribution. I used to emphasize this to every nurse I worked with and encouraged them to ask for help and have a colleague at their side in a patient’s room if they needed it,” Grieshop said.
Retention goes beyond keeping nurses at the bedside; it’s about nurturing professional identity from day one. As Ward put it, “It wasn’t just about learning equipment or protocols; it was about building confidence, critical thinking, and a sense of belonging in a high-stakes environment. That foundation genuinely shaped my entire career. Now, eight years into nursing, I still carry those lessons with me every shift.”
In a healthcare landscape marked by staffing shortages and high turnover, investing in onboarding isn’t optional; it’s essential. When hospitals build orientation programs informed by best practices, they do more than reduce turnover; they preserve patients’ trust, institutional knowledge, and the future of the profession.
