​The long term care industry is no stranger to high turnover rates. In fact, according to the 2023 AHCA/NCAL survey, the average turnover rate for nursing staff in skilled nursing facilities hovers around 53 percent, with some facilities facing even higher rates. Yet behind every statistic is a resident waiting for consistent, compassionate care—and a team struggling to keep up.

Too often, we point fingers at wages or staffing ratios when part of the cause of turnover lies in how we onboard, support, and develop our teams. If we don’t give new hires the tools, mentorship, and ongoing training they need to succeed, they won’t stay. And when they leave, our residents and remaining staff pay the price.

It’s time to rethink our approach. Orientation and ongoing training aren’t optional extras; they are essential investments in quality care, staff engagement, and retention.

Why Orientation Matters More Than Ever

Onboarding isn’t just a checklist of HR paperwork and a quick tour of the building. It’s the first impression new employees get of the organization’s culture, and it can set the tone for whether they stay or leave. Research indicates that 69 percent of employees are more likely to remain with a company for at least three years if they experience a positive onboarding process.

Best practices for an effective orientation include:

• Customized role-specific training. Ensure that RNs, LPNs, CNAs, and ancillary staff each receive targeted content relevant to their scope of practice.
• Peer mentorship. Pair new hires with experienced staff mentors who can provide hands-on support during the first 30-90 days.
• Mission-driven integration. Introduce the facility’s values, resident population, and team expectations—not just policies and procedures.

Ongoing Training: The Secret to Retention

Orientation is just the beginning. Ongoing training—both clinical and interpersonal—keeps staff engaged, competent, and connected. Facilities that invest in regular skill development, leadership pathways, and cross-training report lower turnover and higher staff satisfaction.

Strategies include:

• Quarterly in-services tied to real challenges, like dementia care techniques, infection prevention updates, and PDPM documentation skills.
• Leadership development programs for CNAs and nurses interested in career growth.
• Hands-on coaching. Administrators and DONs who round daily, offering real-time feedback and support, help staff feel seen and valued.

For example, a 120-bed SNF in Texas saw a 22 percent reduction in CNA turnover after implementing a structured CNA career ladder program that included quarterly training sessions and mentorship opportunities. Another facility in Ohio embedded a “Culture of Learning” model, offering monthly education tailored to their quality priorities, and reported improved staff engagement scores and a 15 percent drop in overall turnover.

The Cost of Inaction

When facilities neglect orientation and training, they pay for it—literally. The estimated cost of replacing a single CNA is over $5,000, not to mention the impact on resident care and survey readiness. Multiply that across multiple roles, and the financial and human costs become staggering.

If we want to create nursing homes where staff thrive—and residents receive the quality care they deserve—we must start by rebuilding our orientation and training processes. It’s not enough to hire people; we must invest in them.

Turnover is a symptom. Training is part of the cure.

Veronica Ceaser, MBA, MSN, LNHA, RN, GERO-BC, QCP, RAC-CT, is a long term care consultant and the founder of GEM Healthcare Consulting. With a background spanning bedside nursing to executive leadership, Ceaser specializes in MDS training, quality improvement, and regulatory readiness for skilled nursing teams across the U.S.