Why Your Best New Hires Leave in the First 90 Days⁠—⁠And 5 Ways to Stop It

Four out of five home care employees leave within their first 100 days.¹ 

And at $60,090 to replace each nurse who walks out the door,² the cost isn't just operational; it compounds across every unfilled visit, every overburdened clinician left behind, and every patient whose care is handed off to someone who just met them.

The agencies that break that pattern aren't doing it by working harder on the same approach. They've rebuilt what onboarding actually looks like, and the difference between a program that gets clinicians field-ready fast and one that sends them out underprepared usually comes down to five structural decisions. At Well Care Health, a five-star, family-owned and operated home health and hospice organization with more than 38 years of service across North and South Carolina, we've spent several years working through each of them.

Here's what we've found matters most.

1. Tracks that fit the clinician, not the calendar

The default in home health onboarding has been one program, one pace, everyone through the same door. In our experience, that approach works for some new hires and quietly fails the rest.

Strong programs run at least three tracks. A general track—a hybrid of classroom sessions, independent modules, and joint visits with a preceptor—works well for most new hires. Clinicians responsible for completing OASIS assessments follow a slightly longer onboarding track than those who don't. An accelerated track, designed for clinicians with two or more years of current home health experience, cuts classroom time without cutting competency expectations. And an asynchronous track gives PRN (as-needed) hires who can't commit to a fixed schedule a path through the same material on their own hours, with field skills check-offs built in at the end.

The accelerated track exists because experienced clinicians who move through a program designed for someone with little to no home health experience tend to disengage before they finish. Running one program for everyone means that it fits no one particularly well, and the ones it fits least are usually the ones who leave first.

2. Competency that goes beyond the classroom check-off

A new hire who just watched a skills video (such as Assessment and Measurement of Wounds) and practiced on a mannequin is not a competent clinician; they're a clinician who completed a module, and those are not the same thing. Programs that reduce turnover run three stages of validation, not one.

The first is a digital knowledge track, where clinicians review courses on every skill they'll need before any hands-on validation begins. The second is classroom validation, discipline-specific and observed. The third is field validation with a preceptor, with a signed form for each successful demonstration.

For high-risk skills, including PICC line dressing changes, wound vac care, and four-layer compression wraps, two successful field validations are required before a clinician can perform those skills independently. Doing it on a mannequin and doing it on a real patient in a home setting are not the same, and the gap between the two is where errors happen.

Annual validation works the same way. Initially, clinicians complete a knowledge track that includes courses on all of the procedures they will be performing, so they arrive prepared, then come in for a scheduled in-person validation day, with documentation filed directly to HR. Moving that whole process off paper and onto a digital platform eliminates fax chains, lost forms, and the hours education coordinators spend chasing signatures, and it means the documentation holds up when an auditor asks for it.

3. A preceptor program with structure, compensation, and a ladder

Here's the tension most agencies don't resolve: the clinicians you most want precepting new hires are also your highest producers. Asking them to slow down and teach costs them productivity—which costs them pay—and most programs leave that math unaddressed. The result is preceptors who are reluctant, rushed, or burning out on top of their regular caseload.

What works is building a formal ladder with compensation tied to each rung. A first-tier designation requires completing a course covering communication, expectations, and what a day in the field actually looks like. Those preceptors provide observation opportunities for administrative staff and prospective new hires without having to carry a new hire through a full caseload.

A second-tier designation requires more: tenure beyond 90 days, a manager's letter of recommendation, a candidate statement, and an 80 percent or higher score on a joint-visit evaluation with someone from the education team. Second-tier preceptors own the new hire relationship, following up with education and clinical management on progress and accountability, and they're the ones responsible for presenting new team members in the field.

Both tiers carry additional compensation, and that's what makes the program sustainable. In our experience, when preceptors aren't absorbing a financial hit to teach, they stay engaged, and they become selective about the role in a way that raises the quality of the teaching. Custom knowledge tracks built to reflect the organization's specific programs, language, and expectations, rather than pulled from a generic library, are what the best preceptors use to prepare.

4. Touch points designed to surface problems before resignation

The taper schedule is where most agencies underinvest. Clinicians shouldn't start solo at full productivity, and they don't reach it on the same timeline. Clinicians whose role doesn't include OASIS assessments typically get there around weeks six or seven. Those whose role does are closer to eight or nine weeks. The ramp is deliberate, tracked weekly, and visible to clinical managers, schedulers, and educators simultaneously.

Weekly one-on-ones and separate meetings with education and the clinical manager are structured to catch what new hires won't volunteer. A clinician who says everything is fine at week four and turns in their resignation at week five isn't an outlier—they're a pattern, and it happens when check-ins are treated as status updates rather than diagnostic conversations. 

One question that cuts to the chase: how many hours are you spending on documentation at home in the evenings? A new hire who's still charting until 10 pm at week six is telling you something their “everything's fine” answer isn't, and that number should be visibly declining week over week as the work becomes familiar.

For education, those questions focus on whether clinicians know where to find key resources in the EMR and across the systems they use day to day. For clinical managers, the questions focus on whether the new hire knows how to reach them, understands the call-out process, and can demonstrate that what they're learning in orientation is actually sticking.

A weekly productivity tracker, run by team assistants, shows exactly where each clinician lands relative to where the taper schedule says they should be. Under-productivity gets addressed with support. Overproductivity gets addressed too, because a new hire taking more patients than they were supposed to and struggling because of it is a retention risk that won't announce itself.

5. OASIS training that runs through the entire program

Treating OASIS as a single orientation module is one of the most common gaps in home health onboarding, and one of the most expensive. In a Home Health Value-Based Purchasing (HHVBP) environment where documentation accuracy is tied directly to reimbursement, errors that surface in the field aren't just clinical problems; they're financial ones, and they compound.

For all new hires, the sequence that works is knowledge track first, then practice modules with scenario-based questions that replicate real documentation situations. OASIS boosters (short microlearnings that run three to four minutes each) are assigned to experienced clinicians who come in with home health backgrounds but uneven documentation training. Boosters can also be assigned during the taper period when a clinician is struggling with a specific item, rather than pulling them back through a full course on material they mostly have. 

Learning the concept and then applying it in a simulated scenario before going solo is what closes the gap between knowing how OASIS works and being able to complete it accurately under the pressure of an actual visit. Agencies that carry OASIS training through the full orientation and into the taper period see fewer corrections and better quality scores over time.

The difference between processing new hires and keeping them

The home health workforce crisis is real, and there's no hiring solution that outpaces a retention problem. An agency losing even five nurses a year to preventable early exits is absorbing $300,450 in replacement costs—and that’s before accounting for the visits that don't happen, the patients who don't get seen, and the remaining staff carrying a load that wasn't built for two people.

The five elements above don't require a bigger budget. They require a different structure, one where the track matches the clinician, competency follows them into the field, preceptors are compensated for the actual work of teaching, touch points surface problems before they become resignations, and OASIS training doesn't stop after week one. In our experience, the agencies that build programs this way stop spending the first 90 days of every hire's tenure hoping they stay, and start building the conditions that make staying the obvious choice.

The system behind the structure

None of that structure works without a system behind it, and Medbridge's education and training software for home health is built to support it. Agencies can build custom knowledge tracks for their own programs and policies, and layer in Medbridge's prepackaged onboarding content aligned with ACHC and CHAP requirements. OASIS knowledge tracks and boosters—including short, scenario-based microlearnings—can be assigned to close specific documentation gaps as they show up, rather than re-running a clinician through a full course.

The Skills Competency Manager moves validation off paper, giving education teams, clinical managers, and HR visibility into what's been completed, what's outstanding, and what's overdue, all in one place. And the Clinical Procedure Manual gives clinicians point-of-care guidance for more than 200 home health-specific procedures, so the answer to “how do I do this” is available in the field, not just in a classroom.

Preceptors, educators, and clinical managers still do the work of teaching and supporting new hires. What this gives them is a system built for the way home health runs, so the five elements above are easier to put into place and easier to sustain.

References

1. Home Care Association of America. (n.d.). Home care turnover rate jumps to 80%—HCAOA is here to help members. https://www.hcaoa.org/newsletters/home-care-turnover-rate-jumps-to-80hcaoa-is-here-to-help-members

2. Gamble, M. (2026, April 22). The cost of nurse turnover in 10 points | 2026. Becker's Hospital Review. https://www.beckershospitalreview.com/workforce/the-cost-of-nurse-turnover-in-10-points-2026/