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4 steps to improving EMS retention with onboarding

Employee turnover costs money and morale points, so how can organizations raise retention levels among workers?

The first step to improve the process is to focus on finding the right applicants.

The cost of replacing a medic, both financially and in time invested, is steep. Finding and hiring promising candidates is only one piece of the staffing puzzle. In an EMS1 Special Coverage Series, “Year One: Creating a career path for new EMTs,” learn how to onboard team members to set them up for long-term success, through the first 90 days, the first 6 months and beyond.

By Joey Araiza, RN, BSN

New employee onboarding needs have increased in recent years, as the amount of money and time spent on turnover quickly adds up. Developing an effective strategy requires taking a deeper dive into why increased turnover is occurring, as well as determining what can be done to improve the long-term retention rate of at least two years on the job. Onboarding a new employee can cost anywhere from $10,000 to $20,000 per new employee, depending on what type of service you provide. That cost adds up if you are not consistently retaining employees for more than two years.

There are many reasons organizations hire and need to onboard more frequently, such as employee loss or increasing the budgeted number of full-time equivalents (FTE) to meet the demand. Losses can occur due to retirement, current employees completing advanced degrees and moving on to other jobs and employees being unsuccessful on the job within the first two years of employment.

Although organizations can plan for retirement and employees completing advanced degrees by adding additional staff, you still must review and determine why some employees are unsuccessful in their first two years. Below are four areas that have been identified to invest and focus on in order to increase the speed at which you can hire and onboard, as well as increase the success and retention rates of new employees:

  1. Enhance the identification of applicants that would be a better fit within the organization
  2. Enhance the efficiency of the interview and hiring process
  3. Enhance preceptor development
  4. Improve quality of orientation

1. Hiring qualified applicants assists with onboarding

The first step to improve the process is to focus on finding the right applicants. It should be your goal to choose individuals with all the right qualifications and certifications, as well as focusing on hiring the right “fit.”

To help accomplish this, all applicants who indicate interest should receive two items to complete before additional screening: a checklist of all required certifications, as well as an invitation to take the Culture Index (CI) Tool Survey, or some similar tool.

The Culture Index Survey helps identify individual traits, how individuals are wired and how they work best. Organizations that invest in this type of tool can have their current employees take the survey to see what traits they have and use the results to help determine what traits to look for in applicants that would increase the chances of them being successful in your organization. Once an individual has completed all items on the checklist and the CI tool survey, the next step would be to schedule qualified applicants for an interview.

2. Overhaul the interview and hiring process for better onboarding results

Now that you’ve invested in finding a better pool of applicants, it is time to take a much more proactive approach to shorten the hiring process as much as possible. One way this can be accomplished is through scheduling interview dates three to four times throughout the year, regardless of openings within your organization. This proactive approach can take up to four weeks off the overall hiring process.

In addition to prescheduling interview dates, it is also important to improve the quality of your interviews. One approach would be to develop different steps the applicant would go through during the interview process. These might include a formal interview with the management team and medical director, written and simulation clinical assessments and a peer panel that would allow the applicant to ask questions and interact with current staff. You should also incorporate the CI Tool results of the applicants to tailor your interview questions in an effort to get to know the applicant better.

3. Enhance preceptor development

For an employee to be successful, it is imperative that you have a quality preceptor training and development program in place. It should include defined criteria to identify who can be a preceptor and then include a formal professional development program to ensure the success of the preceptors.

In order to implement this type of program, it is a good idea to start with a small group of individuals first and expand each year as the program evolves. Each organization may have different titles for this type of position – preceptor, clinical field leader – but regardless, it should include some type of additional compensation, as these responsibilities are in addition to their full-time positions.

The group should meet monthly and commit to improving orientation and clinical processes within the organization, as well as participate in the advanced training and professional development that are part of this role. Having a designated, better-trained and prepared group of preceptors will help increase a new employee’s chance of success, as well as increase job satisfaction.


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4. Raise the quality of orientation

Orientation processes must evolve and adapt to the system changes that naturally occur over time. It is important to have your preceptor group or the clinical leadership team evaluate your current orientation process to see what works, in addition to what needs to change to improve the quality of orientation. It can also be beneficial to interview individuals who have recently gone through orientation within the last year to obtain additional feedback.

There are several key areas that any orientation process should incorporate to improve the overall success of the attendees, such as ensuring an adequate length of time a new employee spends in training prior to taking actual patient transports, limiting the assignment of the new employee to only one or two preceptors during orientation and leaving the new employee for a minimum of 90 days with their assigned preceptor on transport shifts. This allows for more consistent monitoring and training of the new employee.

In addition to the more consistent monitoring and training of the new employee, the CI tool survey results can also be useful in the orientation phase by comparing traits and matching up a new employee with a preceptor who has similar traits. The preceptor should also receive information on his or her new-hire’s CI tool survey results and personalize the orientation to the individual.

Investing in onboarding results in quality employees

By implementing this type of onboarding process, you can increase your organization’s overall retention rate, which will reduce the amount of money you spend on orientation as a whole, and you will help you employ valuable, happy, well-trained employees.

About the author

Joey Araiza is vice president of Clinical Services for the LifeFlight Eagle medical transport system managed by Fitch & Associates. She is responsible for the internal and external clinical aspects of the LifeFlight Eagle program serving Kansas City and Northwest Missouri. In addition to serving in that role, she provides clinical insights for the firm’s other air and ground projects.

This article was originally posted June 12, 2018. It has been updated.

For more than three decades, the Fitch & Associates team of consultants has provided customized solutions to the complex challenges faced by public safety organizations of all types and sizes. From system design and competitive procurements to technology upgrades and comprehensive consulting services, Fitch & Associates helps communities ensure their emergency services are both effective and sustainable. For ideas to help your agency improve performance in the face of rising costs, call 888-431-2600 or visit