Assessing Onboarding Quality: How to Determine If a Hospital Will Train You or Throw You to the Wolves

You've landed the ICU offer. The salary is competitive, the unit seems busy, and the interview went well. But there's a question that could determine whether your first year is transformative or traumatic: What does onboarding actually look like?

Some programs set APPs up for success. Others hand you a badge and say "good luck." Here's how to tell the difference before you sign.

Why Onboarding Quality Matters

The first 3-6 months in a new ICU position determine:

• Your clinical confidence and competence
• Your relationship with the medical team
• Your risk for medical errors
• Your likelihood of staying beyond year one
• Your trajectory for career growth

Poor onboarding is the #1 reason APPs leave positions within the first year.

Questions to Ask Before Accepting

About Structure

"Can you describe the formal orientation program for new APPs?"

Green flags:

• Defined duration (4-12 weeks is typical; longer for new grads)
• Written curriculum or competency checklist
• Dedicated preceptor(s) assigned
• Graduated increase in patient load
• Protected time for learning (not counted toward productivity)

Red flags:

• "We tailor it to each person" (often means "no structure")
• "You'll learn as you go"
• "We're a tight team; you'll pick it up"
• No mention of formal evaluation

About Mentorship

"Will I be assigned a specific preceptor or mentor?"

Green flags:

• Named individual (or small group) responsible for your training
• Preceptor has reduced patient load during your orientation
• Clear process for feedback and questions
• Mentorship extends beyond clinical orientation

Red flags:

• "Everyone helps out"
• "You'll work with whoever is on shift"
• No accountability for your development

About Evaluation

"How will my progress be assessed during orientation?"

Green flags:

• Scheduled check-ins (weekly is ideal)
• Competency checklists with documentation
• 30/60/90-day formal reviews
• Clear criteria for completing orientation
• Mechanism for extending if needed

Red flags:

• "We don't really do formal evaluations"
• "You'll know when you're ready"
• Vague metrics

About Support

"What happens if I encounter a situation I'm not ready for during orientation?"

Green flags:

• Clear escalation pathway
• Backup preceptor available
• Culture of asking questions emphasized
• "No one is truly alone their first few months"

Red flags:

• "You shouldn't be encountering anything too crazy"
• "The attendings are always around" (but available?)
• Hesitation in answering

About Resources

"What educational resources are available to new APPs?"

Green flags:

• Access to UpToDate, SCCM Learning, or similar
• Unit-specific protocols and order sets
• Simulation lab for procedures
• Regular didactics or case conferences
• CME budget available during first year

Red flags:

• "We don't really have anything formal"
• "You'll use whatever you have access to"

Red Flags You Might Miss

High APP Turnover

Ask: "How many APPs have been hired in the past 2 years, and how many are still here?"

If they can't answer or the numbers are concerning, probe deeper.

The "Autonomous" Spin

Some units frame "you'll be independent quickly" as a positive. For new grads or APPs new to critical care, this is dangerous.

No Current APPs to Talk To

If they won't let you speak with current APPs—or there aren't any—that's a major red flag.

The "It's Busy" Excuse

"We're so busy that formal orientation is hard" translates to: "You'll be thrown in without adequate preparation."

Vague Procedural Training

"You'll learn procedures as opportunities come up" means you might wait months—or never get properly trained.

What Good Onboarding Looks Like

Phase 1: Orientation (Weeks 1-2)

• HR and compliance requirements
• EMR training (Epic, Cerner, etc.)
• Unit-specific protocols and workflows
• Meet key team members
• Shadow shifts with minimal patient responsibility

Phase 2: Supervised Practice (Weeks 3-8)

• Graduated patient load (start with 2-3, build to full census)
• Direct preceptor oversight
• Daily debriefs
• Procedure observation and practice
• Weekly competency assessments

Phase 3: Supported Independence (Weeks 9-12+)

• Full patient load with preceptor available
• Increasing autonomy in decision-making
• Begin night/weekend shifts with backup
• Focus on complex cases and procedures
• Formal 90-day evaluation

Ongoing (Year 1)

• Assigned mentor for questions
• Quarterly check-ins
• Access to continued education
• Clear pathway to full privileges

For New Graduates: Non-Negotiables

If you're a new graduate APP entering critical care, insist on:

1. Minimum 12-week structured orientation
2. Dedicated preceptor with reduced patient load
3. Formal competency evaluation before independent practice
4. Procedure training plan with documented competencies
5. No overnight shifts until cleared by mentor

Any employer unwilling to provide this is not investing in your success—or patient safety.

Sample Email to Request Onboarding Details

If the interview didn't cover onboarding adequately:

Subject: Follow-Up Question: Orientation Program Details

Dear [Hiring Manager],

Thank you again for the opportunity to interview for the ICU APP position. I'm very interested in the role and wanted to learn more about your onboarding program for new APPs.

Could you share any details about:

• The structure and duration of the orientation period
• How preceptors are assigned
• How competency is evaluated during orientation

I want to ensure I'm set up for success and can contribute meaningfully to the team as quickly as possible.

Thank you, [Your name]

The Bottom Line

A position with mediocre pay but excellent onboarding will often serve your career better than a high-salary job that leaves you struggling. Don't just accept a job—assess whether you'll be supported in it.

The best ICUs view onboarding as an investment, not an inconvenience. If they won't invest in your first 90 days, they won't invest in your next 9 years.