Abstract
AltaMed is one of the largest Federally Qualified Health Centers (FQHC) serving Los Angeles and Orange County areas with over half a million patients primarily from underserved and minoritized communities. AltaMed's mission is to eliminate disparities in health care access by providing quality health and human services through an integrated delivery system for communities in Southern California. The organization has identified concerns related to readiness, confidence, and retention among newly hired nursing staff.
New hires reported that the onboarding process did not adequately prepare them for clinical practice, resulting in low confidence and increased turnover. Many shared that they needed additional time to practice workflows and strengthen EHR proficiency before entering the clinical setting. Staff and leadership found the previous onboarding and precepting process insufficient.
To address these concerns, leadership implemented the Extended Clinical Onboarding (ECO) program. This seven-day orientation allows new hires to complete EHR Training, complete required learning modules, and practice clinical scenarios. The extended onboarding period bridges the gap between classroom orientation and preceptorship, helping staff gain confidence and competence in a supportive environment.
The team also identified the need to redevelop the preceptor program to create more structure and consistency in the preceptor process. There was no standard model for preceptors to train to so new hires experienced different training approaches, leading to inconsistencies in training at each other sites. In response, the team created the Centralized Preceptor Program to bring consistency to the preceptorship experience. The program developed a formal preceptor selection process and standardized preceptor education.
Together, the ECO and Centralized Preceptor Programs strengthen clinical onboarding, promote staff confidence, and support a healthier work environment. As a result, these efforts have significantly improved employee satisfaction. Overall turnover was reduced by 7% for MAs, 30% for LVNs, and 50% for RNs. In addition, Nursing Engagement scores have improved from 4.14 to 4.23, which is higher than the National Healthcare average by of 3.97. By restructuring and standardizing the onboarding and precepting process, AltaMed has made significant efforts to improve nursing satisfaction and retention, creating a healthy environment to work in.
Notes
Presenter notes available in attached slide deck.
References:
American Organization for Nursing Leadership. (2023, August). Nursing Leadership Workforce Compendium: Healthy work environments (Compendium 2.0). https://www.aonl.org/resources/Nurse-Leadership-Workforce-Compendium/Healthy-Work-Environments?check_logged_in=1
Nall, S., Kolenic, A., Jones, B., Kohanski, L., Cocirteu, R., & Hillmon, E. (2024). Integrating the oncology nursing society’s (ons) oncology nurse orientation program into ambulatory nurse onboarding. Oncology Nursing Forum, 51(2), 180C-181C.
Matousek, C. (2023). Standardizing the clinic nurse orientation to improve the onboarding experience. Oncology Nursing Forum, 50(2), B33–B34.
McMahon, E., Boswell, A. S., Germino, M., Heye, D., & Moulton, E. (2024). What do we have in common? Standardizing clinic nurse onboarding. Oncology Nursing Forum, 51(2), 177C-178C.
Organizational socialization: Optimizing experienced nurses’ onboarding. (2023). Nursing Management, 54(12), 1–1. https://doi.org/10.1097/01.NUMA.0000997304.92656.81
Zaire, P. (2017). Structured Onboarding Process to Promote Safety. AAACN Viewpoint, 39(1), 10-.
Laughlin, C. B., Witwer, S. G. (2019). Core curriculum for ambulatory care nursing (4th ed.). Association of Ambulatory Care Nursing.
Bodine, J. L. (2019). Best Practices for the Future of Preceptorship. Journal for Nurses in Professional Development, 35(2), 112–114. https://doi.org/10.1097/NND.0000000000000517
Bodine, J. (2020). Preceptor Selection: The First Step to a Successful Orientation. Journal for Nurses in Professional Development, 36(6), 362–364. https://doi.org/10.1097/NND.0000000000000687
Cotter, E., Eckardt, P., & Moylan, L. (2018). Instrument Development and Testing for Selection of Nursing Preceptors. Journal for Nurses in Professional Development, 34(4), 185–193. https://doi.org/10.1097/NND.0000000000000464
Dimino, K., Louie, K., Banks, J., & Mahon, E. (2020). Exploring the Impact of a Dedicated Education Unit on New Graduate Nurses’ Transition to Practice. Journal for Nurses in Professional Development, 36(3), 121–128. https://doi.org/10.1097/NND.0000000000000622
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Sigma Membership
Non-member
Type
Presentation
Format Type
Text-based Document
Study Design/Type
Other
Research Approach
Other
Keywords:
Preceptorship, Employee Orientation, Employee Orientation--Methods, Preceptorship--Standards, Transition to Practice or Onboarding, Workforce, Precepting, Federal Hospitals
Recommended Citation
Nguyen, Vivian Thuy Vi Min; Tilford, David; Shouse, Laura; Giron, Harold; Ayala, Marvin Alexis; Zacarias, Olive Mae; and Flores, Lorraine, "Boosting Nursing Engagement at an FQHC Through Extended Onboarding and Standardized Preceptorship" (2026). Creating Healthy Work Environments (CHWE). 73.
https://www.sigmarepository.org/chwe/2026/presentations_2026/73
Conference Name
Creating Healthy Work Environments
Conference Host
Sigma Theta Tau International
Conference Location
Washington, DC, USA
Conference Year
2026
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All rights reserved by the author(s) and/or publisher(s) listed in this item record unless relinquished in whole or part by a rights notation or a Creative Commons License present in this item record. All permission requests should be directed accordingly and not to the Sigma Repository. All submitting authors or publishers have affirmed that when using material in their work where they do not own copyright, they have obtained permission of the copyright holder prior to submission and the rights holder has been acknowledged as necessary.
Review Type
Abstract Review Only: Reviewed by Event Host
Acquisition
Proxy-submission
Date of Issue
2026-05-03
Boosting Nursing Engagement at an FQHC Through Extended Onboarding and Standardized Preceptorship
Washington, DC, USA
AltaMed is one of the largest Federally Qualified Health Centers (FQHC) serving Los Angeles and Orange County areas with over half a million patients primarily from underserved and minoritized communities. AltaMed's mission is to eliminate disparities in health care access by providing quality health and human services through an integrated delivery system for communities in Southern California. The organization has identified concerns related to readiness, confidence, and retention among newly hired nursing staff.
New hires reported that the onboarding process did not adequately prepare them for clinical practice, resulting in low confidence and increased turnover. Many shared that they needed additional time to practice workflows and strengthen EHR proficiency before entering the clinical setting. Staff and leadership found the previous onboarding and precepting process insufficient.
To address these concerns, leadership implemented the Extended Clinical Onboarding (ECO) program. This seven-day orientation allows new hires to complete EHR Training, complete required learning modules, and practice clinical scenarios. The extended onboarding period bridges the gap between classroom orientation and preceptorship, helping staff gain confidence and competence in a supportive environment.
The team also identified the need to redevelop the preceptor program to create more structure and consistency in the preceptor process. There was no standard model for preceptors to train to so new hires experienced different training approaches, leading to inconsistencies in training at each other sites. In response, the team created the Centralized Preceptor Program to bring consistency to the preceptorship experience. The program developed a formal preceptor selection process and standardized preceptor education.
Together, the ECO and Centralized Preceptor Programs strengthen clinical onboarding, promote staff confidence, and support a healthier work environment. As a result, these efforts have significantly improved employee satisfaction. Overall turnover was reduced by 7% for MAs, 30% for LVNs, and 50% for RNs. In addition, Nursing Engagement scores have improved from 4.14 to 4.23, which is higher than the National Healthcare average by of 3.97. By restructuring and standardizing the onboarding and precepting process, AltaMed has made significant efforts to improve nursing satisfaction and retention, creating a healthy environment to work in.
Description
AltaMed, one of the largest FQHCs in Southern California, identified low nursing satisfaction along with increased turnover of nursing staff due to a lack of support during onboarding. To address this, Extended Clinical Onboarding (ECO) and Centralized Preceptor Program was developed to provide more support and guidance to new employees. These programs improved confidence, satisfaction, and retention, with nursing engagement scores now 6.6% higher than the national average.