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Getting away from the warm body philosophy
It took about 18 months of hard work, but the staff at Visiting Nurse Association (VNA) of Southeast Michigan in Oak Park found the solution to the recruitment and retention problem that made the agency look like a revolving door for registered nurses.
With a vacancy rate of 30% and a new hire tenure of only six months, agency managers and supervisors were constantly recruiting, interviewing, and hiring new nurses, says Coleen Conway-Svec, RN, MS, MBA, chief operating officer of the agency. "It was obvious that we were not hiring the right people for our field nurse positions, so phase one of our plan to address vacancies was to describe who we wanted to hire," she explains.
Nurse managers worked together to develop a profile of a successful hire. "We looked at the qualities and attributes of our best nurses, added the skills needed for our patient population, and defined the experience that is necessary to work independently to build the profile," Conway-Svec explains. Along with the profile, a behavioral interview guide that includes questions that go beyond having the applicant list skills, education, and experience was developed. Behavioral interview questions ask the applicant to describe how he or she would handle certain situations.
It’s important to find out if the applicant has the customer service skills and the compatibility with other team members during the interview, points out Don Richardson, vice president of administration for the VNA of Texas in Dallas. "While an individualized training program can address weaknesses in certain skills, it’s harder to teach the ability to develop a relationship with a patient, or to work as a team in home health," he explains.
The shadow knows
After pulling together a profile and interview guide, the second phase of VNA of Southeast Michigan’s new hiring program involved development of an "applicant shadow" program in which an applicant spends a half-day in the field with a nurse. "Our new hires who were leaving within six months were saying that they had no idea how lonely they would be or how much paperwork they would have to complete," explains Conway-Svec. "We decided the best way to describe their potential job to them was to take applicants we were seriously considering on patient visits," she adds.
With the consent of the patients, the applicant accompanies a "nurse ambassador" on his or her visits. The applicant is paid for four hours to ride with the ambassador, observe the visits, and ask questions of the ambassador during the half-day. "Our nurse ambassadors are hand-picked, experienced nurses who receive about eight hours of training for the program," Conway-Svec continues. Their training includes review of the agency’s mission, values, programs, and services. "They also spend time learning how to handle tough questions from applicants in a positive manner."
This approach to hiring has a number of benefits that were not expected, she admits. "Bringing field nurses in as ambassadors has created a new group of staff members beyond supervisors and managers, who have a sense of ownership and a stake in the success of our hiring program. We also have an opportunity, through the ambassadors, to observe the applicant in a typical home health setting and judge whether or not the applicant will be a good fit," Conway-Svec adds.
In addition to the results of interviews with supervisors and managers, the ambassadors’ feedback is taken into account when evaluating an applicant. "Many times the ambassadors will intuitively know whether or not the person will make a good home health nurse and we trust their judgment," she explains.
Goal reached in nine months
Within nine months of implementing the new interview process and the applicant shadow program, all positions were filled and the agency enjoys a low turnover rate, Conway-Svec says. "Our turnover rate for new hires within the first six months is only 4%," she says proudly. The reason for VNA of Southeast Michigan’s success is that the agency has moved toward a process of finding the right person for the job, Conway-Svec says. "We no longer have a warm body philosophy in which we just hire anyone. We make sure the job is the right fit for both the agency and the applicant," she adds.