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Nursing retention

Turn to employee references to prevent turnover

BY: Elise Oberliesen on October 24, 2018

Turnover affects every industry, but experts say healthcare is among one of the highest.

StreamlineVerify, a company that produces Office of Inspector General compliant screening software, reports jobs in healthcare weigh in at a 13.5% turnover rate, compared to jobs in hospitality, at 20%.Employee references

Whether nurses resign on their own or are terminated, turnover costs hospitals between $5.2 and $8.1 million per year, suggests a 2016 National Healthcare Retention & RN Staffing Report (NHRRNS). The survey consisted of 120,638 RNs from 138 facilities in the United States.

Reasons why nurses leave

In a LinkedIn survey of 10,000 people who left their jobs, 45% cited lack of career opportunities, while 41% cited unsatisfactory experience with leadership.

Among the reasons nurses leave, according to the NHRRNS report are relocation, personal reasons (such as caring for a child or parent, marriage, disability), career advancement, salary and retirement.

Use reference data when hiring

But what if there was a way to predict nursing turnover before it even happens and pick the right nurse for the job?

When skimming through information provided by candidates’ references, there are certain traits to watch for that can help HR professionals and hiring managers detect which nurses are a better fit, according to Ray Bixler, president and CEO of SkillSurvey, a company that automates the reference checking process online.

In a survey on nurse turnover prediction conducted by the company and published in the Journal of Personnel Assessment and Decisions, data suggests that when references give lower competency ratings and fewer references offer feedback, nurses are, “3.5 times more likely to be terminated for cause within one year of hire,” based on a pool of 10,000 references.

Here’s how it works. “The nurse signs a consent form to let the reference offer their candid response,” Bixler said. “Once the nurse signs the form, the references receive an email.”

This then kicks off the reference checking process.

According to Bixler, several studies conducted by SkillSurvey on turnover prediction confirm the number of references correlates with turnover rates.

“If a hospital seeks reference feedback from five references, and only a few references comply with the reference request, that nurse is more likely to be terminated in their first year on the job,” Bixler said.

He also said nearly 90% of the time, “feedback comes back in a way that validates and supports what the hiring team is hearing about their candidate.”

Survey questions are designed to distinguish whether candidates demonstrate honesty and integrity, said Christine Ottow, director of communications at SkillSurvey. Responses to questions also detect whether a candidate has industry knowledge and the ability to collaborate and build relationships.

“Recruiters can see reference feedback from peers and managers, so they can see the candidate’s areas of strength. Maybe they have high ratings in problem solving but not in personal value commitment.”

When hiring managers see this kind of disparity, Otto said recruiters and hiring managers can use the knowledge to probe a candidate more deeply during a follow-up interview.

Bixler suggests recruiters collect reference feedback in the middle of the hiring process — not at the end. Doing so could help the hiring team ask better questions and learn more about their candidates.

It’s a good idea for all references to receive the same set of questions because it helps standardize the system for the employer, Otto said.  That’s important because HR departments should have processes that allow employers to treat candidates equally, she added.

Skills that improve HCAHPS rankings

The Hospital Consumer Assessment of Healthcare Providers and Systems is a publicly reported patient survey that hospitals must administer after patient discharge. The survey is a requirement of the Centers for Medicare and Medicaid Services for all hospitals. The agency began publicly reporting survey data in 2008.

Scores are like report cards for hospitals. The score can affect a hospital’s reputation because it allows patients — and everyone else — to compare results from other hospitals, according to experts.

HCAHPS scores have an interesting connection to reference checks. In additional research conducted by SkillSurvey, references were asked to rate how well nurses communicate with other nurses, hospital staff, patients and family, Ottow said. When nurses ranked lower on these HCAHPS-related behaviors, including how they treat patients and staff, they were more likely to be fired within their first year on the job, Ottow said.

“Our industrial organizational  psychologist reviewed HCAHPS surveys and aligned our survey questions with the federal government [survey questions],” Ottow said.

job application process

Reference check reminders — read the fine print

HR professionals will want to remember that not all healthcare organizations allow their employees to give references for previous employees.

Let’s say a nurse manager was asked to be a reference, but her hospital policy prohibits it. If the reference violates hospital policy, it can create a host of legal issues for both the reference and the hospital, said Nancy J. Brent, RN, MS, JD, a legal information columnist for Nurse.com.

“Institutions do have policies concerning providing references,” Brent said. “You as a nurse need to know the policy, and if the policy states that you cannot give references for another employee, that needs to be followed.”

Let’s say the nursing candidate does not get hired and they decide to take legal action, the reference could get fired.

“That individual nurse who gave the reference could be terminated because it’s a violation of the institution’s policies,” Brent said. “Some institutions say no nurse employees can give references and [the reference] needs to go through HR or a chief nurse officer.”

The job candidate could claim the reference did not give truthful information or defamed his or her character, Brent said. If this happens, it also could put the hospital at risk of being sued because their employee broke protocol and violated a policy, she said.

Use this checklist to hire nurses

Data collected by StreamlineVerify reports 43% of recent graduates working as hospital nurses stay in their job for just three years, while 17% leave during their first year.

Whether you’re hiring an experienced nurse or a recent grad, SkillSurvey results published in the Journal of Personnel Assessment and Decisions can help recruiters better understand key strengths and weakness between each group.

Following are characteristics for each group:

Entry-level nurses

  • Strengths:
    • Compassionate/caring
    • Dependable/reliable/meets deadlines
    • Attitude/energy
  • Needs improvement:
    • Confidence/assertiveness
    • Experience
    • Time management/prioritizing

Experienced nurses

  • Strengths:
    • Patient care
    • Team orientation
    • Dependable/reliable/meets deadline
  • Needs improvement:
    • Further education
    • Confidence/assertiveness
    • Knowledge

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Elise Oberliesen

Elise Oberliesen has 15 years of combined media and marketing experience. Her work appears on corporate blogs and publications, such as the LA Times, Chicago Tribune and AARP. Her specialties include healthcare, high tech and finance. Elise is a member of the Association of Healthcare Journalists and founder of Big Mountain Media.