Include required screening and credentials, orientation, resident-rights and abuse-prevention education, emergency procedures, infection prevention, role competencies, scheduling expectations, supervision contacts, documentation systems, and acknowledgment of key policies. Requirements vary by role and state, so HR should verify current law and facility policy.
Why the first week decides retention
Many long-term care employees who leave in their first 90 days decide in the first week. Common reasons are feeling thrown onto the floor, not knowing who to ask, and being assigned too many residents too soon. A structured first week reduces early turnover, protects residents from mistakes by staff who are not yet oriented, and covers the training that federal rules require.
Required training topics
Under 42 CFR 483.95, facilities must train staff on topics that include:
- Effective communications, for direct care staff
- Resident rights and facility responsibilities
- Abuse, neglect, exploitation, misappropriation and dementia management, including how to report
- QAPI and the employee’s role in it
- Infection prevention and control
- Compliance and ethics
- Behavioral health, as appropriate to the role
Base the depth of each topic on the employee’s role and your facility assessment. Document every topic with a signature and date.
A day-by-day first week
Day 1: Welcome and essentials
- Meet the administrator, department head and assigned preceptor
- Complete HR paperwork, ID badge and system logins
- Building tour: exits, fire alarms and extinguishers, emergency codes, supply rooms and where to find policies
- Abuse prevention and reporting: who to tell and how quickly
- Resident rights, dignity and privacy, including HIPAA and social media rules
Day 2: Safety and infection prevention
- Hand hygiene, PPE and isolation precautions
- Safe resident handling and lift use, with return demonstration
- Fire safety (RACE and PASS) and the emergency preparedness plan
Day 3: Role-specific skills with a preceptor
- Shadow a preceptor for a full shift on the unit where the employee will work
- For CNAs: ADL care, vital signs, documentation, reporting changes using Stop and Watch
- For nurses: medication pass, EHR documentation, change-of-condition process, admission workflow
Day 4: Supervised practice
- Care for a reduced assignment with the preceptor observing
- Complete competency checklists for key skills
- Dementia care: approaches to behaviors, communication and person-centered care
Day 5: Check-in and plan
- Meeting with the department head or staff development coordinator
- Review completed competencies and what still needs practice
- Set the plan for weeks 2–4, including when a full assignment starts
Keep a single checklist
Use one checklist per employee that lists every required topic, competency and system access, with dates and signatures from the employee and preceptor. File it in the employee record. It is your evidence that training happened.
Check in at 30, 60 and 90 days
Schedule short check-ins with each new hire at 30, 60 and 90 days. Ask what is going well, what is hard and whether they have the tools they need. Track 90-day turnover by department and preceptor. If one unit loses most of its new hires, the problem is the unit’s onboarding, not the people being hired.
Common mistakes
- Putting new staff on the floor alone on day 2 because of short staffing.
- Preceptors who are not trained or given a lighter assignment.
- Covering required topics with a video only, with no check for understanding.
- No follow-up at 30, 60 and 90 days.
Frequently asked questions
Do agency staff need orientation?
Yes. At minimum, provide a unit-specific orientation covering emergency procedures, abuse reporting, infection control and resident-specific needs before the first shift.
Who should be a preceptor?
Experienced staff who communicate well and want the role. Many facilities pay a small preceptor differential.
CMS resources: CMS Nursing Homes guidance and the current 42 CFR Part 483.
Professional-use notice: This operational resource is educational and does not provide medical, legal, individualized employment-law, or emergency advice. It does not guarantee survey or regulatory compliance. Verify current federal requirements, applicable state rules, contracts, and facility policy. Do not enter or upload protected health information (PHI) or resident-identifiable information.