Website Article Assignment
BYSTANDER
BruceFried_2018_Chapter5RecruitmentSe_FundamentalsOfHumanRe.pdf
L e a r n i n g O b j e c t i v e s
1 1 3
After completing this chapter, you should be able to
➤ describe the major steps and decisions involved in recruitment and selection;
➤ discuss the factors prospective employees consider in deciding to accept a job offer;
➤ address the advantages and disadvantages of internal and external recruitment and other
sources of applicants;
➤ compare the concepts of person–job and person–organization fit and their relevance to
recruitment and selection; and
➤ identify the most important factors related to employee turnover and retention and
describe strategies for improving retention.
C H A P T E R 5
R E C R U I T M E N T, S E L E C T I O N , A N D R E T E N T I O N Bruce J. Fried
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C o p y r i g h t 2 0 1 8 . H e a l t h A d m i n i s t r a t i o n P r e s s .
A l l r i g h t s r e s e r v e d . M a y n o t b e r e p r o d u c e d i n a n y f o r m w i t h o u t p e r m i s s i o n f r o m t h e p u b l i s h e r , e x c e p t f a i r u s e s p e r m i t t e d u n d e r U . S . o r a p p l i c a b l e c o p y r i g h t l a w .
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v i g n e t t e
Joan Hampton is director of a nationally known home health care agency that is currently recruiting for a nurse manager. The nurse manager job involves supervising other nursing and ancillary staff, managing the scheduling process, coordinating nursing activities with other home health services, providing direct service, and ensuring compliance with poli- cies, procedures, and regulatory requirements. Following are the major job requirements:
• Current and unencumbered state license to practice as a registered nurse • Three years’ experience as a registered nurse, at least one of which must involve
full-time experience in providing direct patient care in the home health setting; one year supervisory or management experience preferred
• Current cardiopulmonary resuscitation (CPR) certification • Ability to assess patient status and identify requirements relative to age-specific needs • Excellent verbal and written communication skills • Strong interpersonal skills and ability to work in teams • Knowledge of federal and state rules and regulations, Joint Commission standards,
and other regulatory requirements • Strong fiscal planning and human resources management skills
Sandra Goodman has been with the home health agency for five years and has proven to be a diligent, hardworking, and reliable employee. For the past 15 months, she has held the temporary position of nurse manager and has done well. She sets high standards for herself, has become an expert in the agency’s reporting and billing procedures, and under- stands regulatory requirements and the agency’s financial operations. Sandra has applied for the permanent position of nurse manager, for which she has many of the qualifications.
Along with Sandra, Michaela Roberts is being considered for the position. Michaela has seven years of experience in home health care and three years of experience as an emer- gency department nurse. However, she has no supervisory experience and limited financial skills. Several nurses in the agency interviewed and liked Michaela and recommended her.
Joan is inclined to offer the job to Sandra because of her experience and because she could step into the position with little training. However, several nurses have come to Joan indicating that they will quit if Sandra is offered and accepts the job: Although Sandra has performed well in the temporary nurse manager role, she has an autocratic personality and management style that have alienated many of the nurses. She has been known to lose her temper and insult the staff for failure to follow procedures.
Whereas the other nurses support hiring Michaela, Joan believes that she does not have the time to properly orient and train her for the position. Michaela is bright and indi- cates a willingness and aptitude to learn, but Joan is much more comfortable and secure with Sandra. However, she is also concerned with morale problems and turnover if she decides to hire Sandra. What advice would you give Joan, and why?
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in t r O d u C t i O n Staffing an organization can be defined as “getting the right people into the right positions in a timely manner.” Yet while this definition is correct, staffing also involves determining where to find applicants, defining criteria for selecting the most appropriate applicant, and doing all we can to keep people—retain them—in the organization. Thus, recruitment refers to various methods to generate a pool of applicants. Selection involves choice: Who among applicants should be chosen for a particular position? Retention refers to keeping people in the organization after they have been hired.
We address these three important processes—recruitment, selection, and reten- tion—in a single chapter because they are integrally interrelated and also related to other human resources management (HRM) functions. These human resources (HR) practices are highly interdependent. For example:
◆ The success of recruitment efforts determines in part how selective an organization can be in hiring. An organization can be more selective when there is a relatively large supply of qualified applicants from which to choose.
◆ Developing a recruitment plan that seeks to generate a pool of qualified applicants depends first and foremost on the existence of an accurate, current, and comprehensive job description.
◆ Employee retention may be enhanced by the effectiveness of an organization’s orientation and socialization processes.
As with all HRM functions, organizations must be cognizant of legal considerations when developing and implementing recruitment and selection procedures. For example, because it is illegal under Title VII of the Civil Rights Act to discriminate in hiring based on race, gender, and other characteristics, those involved in employee selection need to be diligent in ensuring that these factors do not bias hiring decisions. (Chapter 3 on legal issues includes a detailed description of Title VII; chapter 11 discusses diversity and inclu- sion in the workplace.)
re C r u i t m e n t Recruitment refers to the means by which organizations attract qualified individuals on a timely basis and in sufficient numbers and encourage them to apply for jobs. In starting a recruitment effort, organizations should be clear about the nature of the job and the desired qualifications. They may also consider additional questions, such as the following:
◆ Should we recruit and promote from within, or should we focus on recruiting external applicants—or both?
recruitment
The means by which
organizations attract
qualified individuals
on a timely basis and
in sufficient numbers
and encourage them to
apply for jobs.
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◆ Should we consider alternative approaches to filling jobs with full-time employees, such as outsourcing, flexible staffing, and hiring part-time or temporary employees?
◆ How important is it for employees to fit in with the culture of the organization? Should we favor applicants who better fit the culture but may require additional training to improve their technical skills?
An organization’s recruitment success depends on many factors, including the attrac- tiveness of the organization and the job; the community and the labor market in which it is located; unemployment and the nature of the economy; the organization’s work climate and culture; managerial attitudes and behavior; and workload.
Recruitment can be challenging for many organizations and specific jobs. A 2016 report by the Society for Human Resource Management (SHRM) found that more than two-thirds of human resources professionals reported challenging aspects of recruitment. Half of the surveyed organizations reported such factors as a low number of applicants, lack of work experience among applicants, and competition from other employers. Among human resources professionals, 84 percent reported that they had seen skills shortages in the previous years (SHRM 2016b).
Organizations involved in health, social assistance, and manufacturing reported the highest levels of recruitment troubles. Not surprisingly, 70 percent of organizations said they use social media in their recruiting (SHRM 2016b).
In the next section, we look at how individuals make choices about seeking jobs and accepting job offers. These are extremely personal decisions, dependent on a multitude of factors. However, there are some common factors that recruiters need to be aware of.
f a C t O r s t h at i n f l u e n C e j O B C h O i C e
Accepting a job offer is a big decision with possibly lifelong implications. What do potential employees look for in a job? After an individual is offered a position, how does that person make the decision to accept or reject the offer? Applicants are certainly concerned with compensation, benefits, and opportunities for career mobility and promotion. They may also consider the availability of other positions and the competitiveness of the job market.
Applicants are sensitive to the attitudes and behaviors of the recruiter or whoever is their first contact with the organization. First impressions are potent, because the sense of whether one fits in with the organization is often decided at this stage. Early negative first impressions may be difficult to reverse. Applicants are more likely to accept positions in organizations that share their values and style.
These considerations lead to the important issue of how organizations communicate their values to potential job applicants. The examples that follow indicate how organizations
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communicate their values and why they should be considered an “employer of choice.” Consider the following recruitment message for WakeMed, a large health system in Raleigh, North Carolina:
At WakeMed Health & Hospitals, we are guided by a simple—yet powerful—mission: to improve the health and well-being of our community by providing outstanding and compassionate care to all. To deliver on this mission, WakeMed employs the “best minds and the biggest hearts” in the business. Our team comprises a group of talented, passionate professionals whose commitment to WakeMed is all about putting patients first. We promote a diverse workforce and are proud to offer competitive salaries, com- prehensive benefits, educational opportunities and flexible schedules that allow our employees to excel personally and professionally. We think it’s pretty simple—we care for our employees and our employees care for the community. (WakeMed 2017)
The Cleveland Clinic focuses on joining “a culture that encourages excellence”:
Healthcare is evolving, and Cleveland Clinic is transforming healthcare—pushing the limits and paving the way to establish new practices and set new standards. We believe in moving away from the physician-centric model of care and instead putting the patient at the center of everything we do. We are developing the most innovative patient experi- ences with our constant investment in continuing education and leadership development programs. (Cleveland Clinic 2017)
On its main recruitment page, the Mayo Clinic emphasizes that “as a Mayo Clinic nurse, you will become a vital member of a dynamic team at one of the world’s most exceptional health care institutions. You will also discover a culture of teamwork, profes- sionalism and mutual respect, and—most importantly—a life-changing career” (Mayo Clinic 2017a).
Emory Healthcare promotes itself to prospective employees in this simple but pow- erful message:
At Emory Healthcare, we bring the science side and the human side together to change the face of health care. Our team members are courageous individuals who are willing to challenge the status quo and help find solutions to complex problems. They are empowered to influence change for, and with, our patients, their families, the community and each other. As one of the leading academic medical systems, Emory Healthcare is eager to share what we learn with hospitals around the country, and the world, to define a new standard of care for humankind. We believe that, ultimately, we’re all in this together. Are you ready to join us? (Emory Healthcare 2017)
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Kaiser Permanente (2017a) emphasizes that “diversity, inclusion, and culturally competent medical care are defining characteristics of Kaiser Permanente’s past, present, and future,” noting its obligation “to create a diverse and inclusive environment that encourages our employees to reach their full potential.”
Organizations promote themselves as good places to work by appealing to a variety of employee needs, interests, and values. Understanding the factors that affect job choice is central to developing effective recruitment strategies. It is valuable to distinguish between individual characteristics and job characteristics.
Individual characteristics are personal considerations that influence a person’s job decision. The factors that lead a family physician to accept employment with a rural health center may be distinct from those that lead a nurse to accept employment with an urban teaching hospital. Life and career stage may affect the relative importance of these factors. Job characteristics may include such job-related decision-making factors as compensation, challenge and responsibility, advancement opportunities, job security, geographic location, and employee benefits. It is difficult for an organization to create the “perfect” job because no two individuals are the same in their individual characteristics and job preferences (see “Critical Concept” sidebar).
Compensation and benefits (discussed more fully in chapter 8) are often key elements in an individual’s decision to accept a position. For some healthcare positions, compen- sation is complicated by differential pay rates, hiring or signing bonuses, and relocation assistance. Hot-skill premiums—temporary pay premiums added to base pay for employees
with in-demand skills—have become particularly common in healthcare, although premiums usually remain in place even after market pressures ease. These premiums may be structured in a number of ways, including incorporating the premium into the individual’s salary, providing a hiring or annual bonus, and slotting an employee into a higher salary range than is usually warranted for that job (Berthiaume and Culpepper 2008; Mercer 2014).
The relative importance of compensation to employees is complex. Under certain circum- stances, employees may leave an organization for another to obtain only a small incremental increase in compensation. In other cases, employees may stay with an organization even when offered a gen- erous improvement in compensation by another organization.
The amount of challenge and responsibil- ity inherent in a particular job is frequently a key
individual
characteristics
Personal
considerations that
influence a person’s job
decision.
job characteristics
Job-related decision-
making factors such
as compensation,
challenge and
responsibility,
advancement
opportunities, job
security, geographic
location, and employee
benefits.
CRITICAL CONCEPT The “Perfect” Job
Is there a “perfect” job? Rarely. When a person accepts a
job, the person always makes compromises and trade-offs.
For example, the organization may not be able to meet an
applicant’s initial expectations for pay, but professional de-
velopment and career opportunities may offset the lower sal-
ary enough to make the job seem worth accepting. A parent
concerned about childcare responsibilities may reject an offer
of an otherwise perfect job because the two-hour daily com-
mute places undue stress on the child and parents. Employ-
ers and applicants must be aware of the multiple factors that
go into a job acceptance decision and the weight placed on
each of these factors.
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C h a p t e r 5 : R e c r u i t m e n t , S e l e c t i o n , a n d R e t e n t i o n 1 1 9
job choice factor; professionals typically seek positions that put their training to best use. Many applicants value jobs with advancement and professional development opportunities; however, there are often limited opportunities for clinical staff to advance while continuing to do clinical work. Advancement opportunities for technically trained individuals may be limited to management positions. For some individuals, taking on management respon- sibilities may lead to feelings of loss of their professional identity. Even more important is the fact that clinically trained people often do not have the required management skills to work in a managerial capacity. The clinical nurse specialist (CNS) position is an example of how nursing has sought to retain nurses in clinical positions while offering career growth and professional development (see “Did You Know?” sidebar).
Job security is clearly an important determinant of job choice. The current healthcare and business environment is characterized by great uncertainty, in part due to organizational change including mergers, acquisitions, and downsizing. Fear regarding job security was once limited largely to blue-collar workers, but today professionals and managers also feel at risk.
DID YOU KNOW? Clinical Nurse Specialists
Clinical nurse specialists (CNSs) are advanced practice nurses (APNs) who hold a mas-
ter’s or doctoral degree in a specialized area of nursing practice. Their area of clinical
expertise may be in
• a population (e.g., pediatrics, geriatrics, women’s health),
• a setting (e.g., critical care, emergency room),
• a disease or medical subspecialty (e.g., diabetes, oncology),
• a type of care (e.g., psychiatric, rehabilitation), or
• a type of health problem (e.g., pain, wounds, stress).
In addition to the conventional nursing responsibilities that focus on helping pa-
tients prevent or resolve illness, a CNS’s scope of practice includes diagnosing and
treating diseases, injuries, and disabilities within the individual’s field of expertise.
Clinical nurse specialists provide direct patient care, serve as expert consultants for
nursing staff, and take an active hand in improving healthcare delivery systems. Re-
search has demonstrated that the work of clinical nurse specialists has been associated
with reduced hospital costs and length of stay, reduced frequency of emergency room
visits, and fewer complications among hospitalized patients.
Source: Adapted from National Association of Clinical Nurse Specialists (2017).
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Geographic location and other lifestyle concerns may be highly important to appli- cants, particularly for individuals in dual-income families, in which the potential for spouse employment may play a significant role in acceptance decisions.
Employee benefits continue to grow in importance in job acceptance. In some highly competitive fields, many companies have moved beyond traditional benefits, such as health insurance and vacation pay, into such areas as membership in country clubs or health clubs, on-site day care, and financial counseling. However, given a US healthcare environment facing increasing financial pressures, it is likely that employee benefits will be reduced in coming years.
Exhibit 5.1 illustrates how three hypothetical job applicants may assess the relative importance of particular job features. Although the table oversimplifies the job choice process, it shows how personal preferences and life circumstances may affect job choice. The first column briefly describes each applicant. The second column states each applicant’s minimum standards for acceptance along four dimensions: pay, benefits, advancement opportunities, and travel requirements. These four dimensions are sometimes categorized as noncompensatory standards. That is, no other element of the job can compensate if these standards are not met; they are deal breakers. Column 3 is a description of a hypothetical job being considered by the job applicant. After looking at the minimum standards for job acceptance (column 2), consider how each of the three applicants would assess the accept- ability of the particular job. For example, person 2 views health insurance as an absolute requirement for acceptance, and person 3, who does not like to travel, will be unlikely to accept a job that requires substantial travel, regardless of anything else.
t h e r e C r u i t m e n t p r O C e s s
The human resources plan should provide a foundation of information for recruitment. A human resources plan includes specific information about the organization’s strategies, the range of jobs required by the organization, core organizational values, and recruitment and hiring practices. Those involved in recruitment and selection must have a thorough understanding of the position that needs to be filled, the position’s required competencies, and its relationship to other positions in the organization. A recruitment effort should begin with a job analysis that provides information about the job and required qualifications (job analysis and job design are discussed in chapter 4).
Recruitment requires an assessment of the external environment, specifically informa- tion about the supply of potential applicants, and a market analysis that provides information about compensation and benefits for people who hold similar jobs in other organizations. Many organizations obtain this information through wage and salary surveys. It is also important to review the results of previous recruitment efforts. Have they been successful? What have been the major obstacles faced in identifying and hiring qualified applicants? External recruitment sources, such as colleges, competing organizations, professional asso- ciations, and social media should be assessed to determine whether they have yielded suc- cessful candidates in the past. Logistical issues may also be examined, such as the timing
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Applicant Minimum Standards for Job Acceptance Job Description
Person 1: 23 years old, single
Pay: At least $40,000
Benefits: Medical insurance; retire- ment savings plan
Advancement opportunities: Very important
Travel requirements: Unimportant
Job: Provider relations coordinator
Pay: $45,000
Benefits: Medical and dental insur- ance with relatively high deductible; optional vision insurance; basic and supplementary life insurance; short- and long-term disability coverage; retirement savings plan with employer matching
Advancement opportunities: Recruit- ment done internally and externally
Travel requirements: Average 25 percent travel
Person 2: Sole wage earner for large family
Pay: At least $70,000
Benefits: Medical and dental insur- ance; optional vision insurance; basic and supplementary life insurance; short- and long-term disability cover- age; retirement savings plan with employer matching
Advancement opportunities: Very important
Travel requirements: Prefers not to travel more than 25 percent of the time
Job: Healthcare consultant
Pay: $68,000
Benefits: Medical, dental, and vision insurance with low deductibles and copays; basic and supplementary life insurance; short- and long-term dis- ability coverage; retirement savings plan with employer matching
Advancement opportunities: Strong history of promotions within one year
Travel requirements: Average 50 percent travel
Person 3: Spouse of high-wage earner
Pay: At least $35,000
Benefits: Unimportant
Advancement opportunities: Unimportant
Travel requirements: Difficulty travel- ing more than one week per year
Job: Academic medical center re- search assistant for multisite clinical trial
Pay: $45,000
Benefits: Medical, dental, and vol- untary vision insurance; basic and supplementary life insurance; short- and long-term disability coverage; re- tirement savings plan with employer matching
Advancement opportunities: None
Travel requirements: Three days per quarter to meet with other research site personnel
exhiBit 5.1 Three Hypothetical Applicants
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of a recruitment effort; for some positions, seasonal factors are relevant, such as the time of graduation from nursing school (Rossheim 2017).
As part of planning for recruitment and reviewing past recruitment efforts, additional questions include the geographic scope of the search. Will this job require an international search, or will the local labor market suffice? Or is it possible to recruit an individual from inside the organization, or a previous job applicant? For internal searches, an updated human resources information system (HRIS) can provide helpful information. Many systems include information described in exhibit 5.2. A skills inventory database maintains information on current employees’ performance records, skills and certifications, educational background, training completed, seminars attended, work history, and other job-related data. Such a database is useful for many HR functions, including broadening the pool of applicants and succession planning. (Succession planning, discussed in chapter 6, is particularly critical for higher-level employees.) Some organizations use personnel replacement charts, which show the current position and promotability for each position’s potential replacement. In addition, former employees who left under favorable conditions are increasingly a source of recruit- ment, and evidence shows that such “boomerang” employees who come back after time away bring unique strengths to an organization, including familiarity with the organization and its culture, while also bringing new ideas and experiences to the workplace (Browne 2016). They may also send an implicit message to current employees about the desirability of the work environment (Green 2009). Organizations should also maintain records of applicants who were not hired in the past because they may be qualified for positions that arise in the future.
Recruitment and selection can be costly, and we often do not consider the wide range of expenses associated with hiring. For a single position, the cost may be equivalent to, and in some cases may exceed, the position’s annual salary. As a result, it is important to measure the efficiency of the recruitment process. Exhibit 5.3 shows measures for assessing the effectiveness and efficiency of the recruitment process. Each of these measures varies
human resources infor-
mation system (HRIS)
An integrated informa-
tion system designed to
provide managers with
information for human
resources (HR) decision
making.
skills inventory
A manual or electronic
system designed to
keep track of employ-
ees’ experiences,
education, skills, knowl-
edge, abilities, and
other characteristics.
personnel replacement
charts
Lists of key personnel in
an organization and their
possible replacements in
the organization, includ-
ing information about
their current perfor-
mance and promotability.
HRIS Data Uses in Recruitment
Skills and knowledge inventory Identifies potential internal candidates
Previous applicants Identifies potential external candidates
Recruitment source information: • Yield ratios • Cost • Cost per applicant • Cost per hire
Helps in the analysis of cost effectiveness of recruitment sources
Applicant tracking Provides an automated method for labor- intensive recruitment tasks
Employee performance and retention information
Provides information on the success of recruitment sources used in the past
exhiBit 5.2 Human Resources
Information System (HRIS) Recruitment
Data
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Type of Cost Expenses
Cost per hire Advertising, agency fees, employee referral bonuses, recruitment fairs and travel, and sign-on bonuses
Staff time: salary; benefits; and overhead costs for employees to review applications, set up interviews, conduct interviews, check references, and make and confirm an offer
Processing costs: opening a new file, medical examination, drug screening, and credential checking
Travel and lodging for applicants; relocation costs
Background checks
Drug-testing expenses
Travel and expenses (for applicant and recruiter)
Prehire health screenings
Immigration expenses
Sign-on bonuses
Orientation and training
Note: Cost-per-hire measures can be calculated for all referral sources or by individual referral source.
Application rate Ratio of referral factor: number of candidates to number of openings
Applicants per posting
Qualified applicants per posting
Protected class (group of individuals protected under a particular law) applicants per posting
Number of internal candidates, number of qualified internal candidates
Number of external candidates, number of qualified external candidates
Time to hire Time between job requisition and first interview
Time between job requisition and offer
Time between offer and acceptance
Time between job requisition and starting work
Recruitment source effectiveness
Offers by recruitment source
Hires by recruitment source
Employee performance (using performance evaluation information and promotion rates)
Employee retention by recruitment source
Offer acceptance rate (overall and by recruitment source)
Recruiter effectiveness
Response time, time to fill, cost per hire, acceptance rate, employee performance, and retention
Miscellaneous Materials and other special or unplanned expenses
Reference checking
New employee orientation
Source: Adapted from Fitz-enz and Davison (2002); SHRM (2015a).
exhiBit 5.3 Measures of Recruitment Effectiveness and Efficiency
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depending on the job, and a good HRIS and cost-accounting system can help the organiza- tion understand the major costs associated with recruitment and selection.
r e C r u i t m e n t s O u r C e s
An initial step in the recruitment process is applicant sourcing, specifying where qualified applicants are located. Internal recruitment refers to promotion or transfers from within the organization. External recruitment regards applicants from outside the organization. Each source of applicants has its advantages and disadvantages, as shown in exhibit 5.4. Internal recruitment may be advantageous because candidates are generally already known to the organization; managers are familiar with the applicant’s past performance and future potential. Internal applicants are also familiar with the organization and may not require as much start-up time as external applicants. Internal hiring may also build morale because it signals to other employees that there are opportunities for advancement.
One possible negative result of internal recruitment is that technically skilled employ- ees who are promoted to management positions may lack management skills. Such promo- tion exemplifies the Peter Principle, a common phenomenon in which successful employees continue to be promoted until they reach one position above their level of competence. The principle also notes that on reaching one’s level of incompetence, it is likely that the individual will not be fired, and thus the tendency is for others to work around this person (Asghar 2014), which leads to organizational inefficiency. The Peter Principle, named after educator Laurence Johnston Peter, who popularized the theory, can be avoided with careful employee selection and training procedures.
Internal recruitment may also cause disarray in the organization. A promotion may create a ripple effect—one individual moves into another position, leaving a vacancy; this vacancy, in turn, is filled by someone else, who causes another vacancy, and so forth.
An advantage of external recruitment is that candidates from outside the organi- zation may bring new ideas. The organization can specifically target candidates with the skills needed rather than settle for an internal candidate who may know the organization but lack the required skills and knowledge for the position. External applicants tend to be unencumbered by political alliances and internal conflict and therefore may be easier to bring into a difficult political environment than an internal applicant. This lack of com- plication is often one of the reasons for selecting a new chief executive officer from outside the organization.
Some applicants are not easy to characterize as internal or external—for example, those who have worked for the organization in a temporary or part-time capacity. This practice is common in nursing, where traveling or agency nurses may apply or be recruited for full-time positions.
Current employees sometimes refer friends and acquaintances for positions in an organization. Employee referral is an excellent source of applicants because the referring
internal recruitment
An approach to
employee recruitment
that emphasizes iden-
tifying and recruiting
applicants who are
already members of
the organization.
external recruitment
An approach to
employee recruitment
that emphasizes
identifying and
recruiting applicants
outside the
organization.
Peter Principle
The theory that
employees in an
organization will
be promoted to
their highest level
of competence and
then be promoted to
and remain at a level
at which they are
incompetent.
employee referral
An approach to
recruitment in which
current employees
help identify promising
applicants.
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employee knows the organization and can do an initial screening of the applicant. Employee referral can be a powerful recruitment strategy, yielding employees who typically stay longer with the organization and who exhibit higher levels of loyalty and job satisfaction than do employees recruited through other mechanisms (Salopek 2010). This practice is becom- ing increasingly popular in healthcare. In fact, Kaiser Permanente offers cash rewards for employee referrals for selected positions and has a website devoted to employee referrals
Recruiting Internal Candidates
Advantages Disadvantages
May improve employee morale and encourage valued employees to stay with the organization
Permits greater assessment of applicant abilities; candidate is a known entity
Draws from pool of applicants who have a good understanding of the organization
May be faster, and may involve lower cost for certain jobs
Provides good motivation for employee performance
May reinforce employees’ sense of job security
May cause morale problems among those not selected
May lead to “inbreeding” (when an orga- nization depends too heavily on internal recruitment, it may deny itself fresh talent and new ideas)
May require strong training and manage- ment development activities
May manifest the Peter Principle (em- ployees may be promoted to their highest level of competence and then be promot- ed to and remain at a level at which they are incompetent)
May cause ripple effect in vacancies
Recruiting External Candidates
Advantages Disadvantages
Brings new ideas into the organization
May be less expensive than training inter- nal candidates
Draws candidates who come without dysfunctional relationships with others in the organization and without involvement in organizational politics
May cause morale problems for internal candidates who were not selected
May be difficult to obtain reliable informa- tion about applicant
May identify candidate who has technical skills but does not fit the culture of the organization
May require longer adjustment and socialization for new employee compared with internal candidate
exhiBit 5.4 Advantages and Disadvantages of Internal and External Recruitment
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(Kaiser Permanente 2017b). According to Todd Davis, a recruiting consultant with a large California physician group, “Peer referrals are the most powerful recruiting tool. When I get a referral in-house I know the candidate is going to have the skills and the interest, because a colleague has already made the contact” (Zappe 2006, 30). Some employee referral programs give financial rewards to employees if the new hire remains with the organization for a defined period.
Employment agencies or executive search firms may be used to recruit applicants. These organizations help firms with recruitment and provide assistance for people seeking jobs. Agencies may specialize in particular types of searches and typically work either on a commission or on a flat-fee basis.
th e re C r u i t i n g me s s a g e i n re C r u i t m e n t a n d se l e C t i O n The major objective of the recruitment and selection process is to ensure that the right applicant will accept the job offer. Effective recruitment messages ensure that applicants understand the job and its qualifications. Overall, the following four types of information should be communicated:
1. Applicant qualifications: education, experience, credentials, and any other qualifications, within legal constraints
2. Job basics: title, responsibilities, compensation, benefits, location, and other pertinent working conditions (e.g., night work, travel, promotion potential)
3. Application process: deadline, resume, cover letter, transcripts, references, and contact person and address for the application packet
4. Organization and department basics: name and type of organization, department, and other information about the work environment
The recruiting message should be present- able in a flexible online format because more than half of US adults use the Internet in their job searching (see “Did You Know?” sidebar).
DID YOU KNOW? Internet Job Searching
Job searching on the Internet continues to grow at a remark-
able pace. The Pew Research Center (2015) reports that 54
percent of US adults have searched for work online. In a
recent two-year period, of Americans who have looked for
employment, 79 percent used online resources in their most
recent job search and 34 percent state that the Internet was
the most important tool in their job search. Twenty-eight per-
cent of Americans have used a smartphone in their job search,
and half of these individuals completed their job application
through their phone. Interestingly, those without a college de-
gree were more likely to use a smartphone for completing an
online job application and creating a resume or cover letter.
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t h e r e a l i s t i C j O B p r e v i e w
A realistic job preview refers to the process of giving applicants a true picture of a job, including its strengths and weaknesses. This preview may include verbal information, dis- cussions with job incumbents, employee shadowing, and other methods. Use of realistic job previews is related to higher performance and lower attrition from the recruitment process, lower initial expectations, lower voluntary turnover, and lower turnover overall. Their use in healthcare is growing and has been shown to be an evidence-based retention strategy (Gilmartin, Aponte, and Nokes 2013).
e va l u at i n g t h e e f f e C t i v e n e s s O f r e C r u i t m e n t
Recruitment can be expensive, so it is important to evaluate the effectiveness of recruitment efforts. The evaluation process depends on reliable and comprehensive applicant data, a well-functioning HRIS, applicant quality and disposition, and recruitment costs. Common measures of a recruitment function’s success include the following:
◆ Quantity and quality of applicants. Effective recruitment yields a sufficiently large number of candidates who meet the minimum requirements.
◆ Overall recruitment cost and cost per applicant. This calculation helps determine the cost-effectiveness of recruitment methods.
◆ Diversity of applicants. Attracting applicants who represent the diversity of the service population is frequently a recruitment goal.
◆ Recruitment time or time-to-fill. The more time spent on proper recruitment, the greater the chance that the ideal candidate will emerge. However, a lengthy recruitment process frequently results in greater costs, disruption of service or work, and potential dissatisfaction among current employees who must fill in for the vacant position.
se l e C t i O n Selection refers to the process of evaluating job applicants with the goal of identifying the best person for a position. Employee selection is largely a matter of predicting which applicant is most likely to achieve success. Success may be defined as not only proficiency in the job but also longevity in the position and fit with the culture of the organization.
Selection must be distinguished from simple hiring. In selection, a careful analysis of an applicant’s qualifications is performed. However, job offers are sometimes extended with
realistic job preview
A process in which
applicants are given
a true picture of
a job, including
its strengths and
weaknesses, through
verbal information,
discussions with job
incumbents, employee
shadowing, and other
methods.
selection
The process of
evaluating job
applicants with the
goal of identifying
the best person for a
position.
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little or no systematic evaluation of applicants—a common example is hiring an individual based on political connections, where non-job-related factors supersede objective measures of suitability. There are also circumstances when a position must be filled quickly or when there is a labor shortage in a particular area. In these cases, an organization may simply hire whoever meets the minimum qualifications. In organizations in remote or otherwise undesirable locations, applicant availability may be the key criterion for selection.
t h e Q u e s t i O n O f f i t
Selection processes seek primarily to ensure person–job fit. The goal of selection is simply to determine whether the applicant has the competencies to do the job. An accurate job description provides the foundation for beginning the process of evaluating the qualifica- tions of applicants.
In many circumstances, an organization may be interested in more than technical qualifications. There may also be interest in how well a potential employee will fit into the organization, which could include team citizenship, relationships with coworkers, customer service attitudes and skills, and work-related values. Person–organization fit can be critical to job success. Person–organization fit is almost always more difficult to assess than technical skills, and it is sometimes impractical to hire on this basis, particularly when recruitment for difficult-to-fill positions may generate only a few applicants. In this situation, it is dif- ficult to be highly selective in hiring.
Decision makers should discuss the appropriate balance between person–job and person–organization fit, depending on the position (see “Critical Concept” and “Debate Point” sidebars). Hiring a nurse on a psychiatric unit requires a high level of person– organization fit because nurses must interact closely with staff and patients, and fitting into the therapeutic setting is critical to success, whereas person–organization fit may be less important in hiring a medical data-entry clerk, whose work may entail relatively little interaction with
others. There are even situations in which employ- ers might not want someone who closely fits the culture, such as when the culture is dysfunctional and the organization wants to bring in people with new ideas and approaches to improve it.
Through such processes as targeted selec- tion and behavior-based interviews, organizations have attempted to hire applicants who fit the culture of the organization. Women and Infants Hospital of Rhode Island made an explicit effort to select employees on cultural fit, believing that people “must be qualified to do the job, but they also require the right personality.” After starting
person–job fit
The traditional
foundation for human
resource selection,
in which a successful
applicant possesses
the knowledge, skills,
and abilities required
for the job.
person–organization fit
An approach to
employee selection
that emphasizes the
extent to which an
applicant’s attitudes,
behaviors, values,
and beliefs align with
the culture, norms,
and values of the
organization; usually
more difficult to
measure than person–
job fit.
CRITICAL CONCEPT Screen for Technical Qualifications, Hire for Fit
Hiring involves more than assessing applicants on the basis
of their technical qualifications. It is important to assess the
applicant’s fit with the organization’s culture and style of
work. Whether an employee fits into the organization may
determine the person’s success on the job and longevity in
the position.
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a hiring program using behavior-based interviews and in-depth analysis of candidates, the hospital saw patient satisfaction rise from the 71st percentile to the 89th percentile nation- ally, while turnover declined 8.5 percent. Labor disputes also decreased, while productivity increased (Greengard 2003).
s e l e C t i O n t O O l s
To help make hiring decisions, employers use selection tools, procedures to obtain job- related information about applicants.
A critical incidents analysis is useful for uncovering the hidden or less formal aspects of job performance. The process starts with identifying examples of excellent and poor per- formance by current or potential jobholders. Examples may be drawn from the experience of current jobholders and from the insights of individuals knowledgeable about the job. For a new job in an organization, we may need to ask people knowledgeable about job expectations to ob- tain examples of poor and excellent performance. After these behaviors are collected, they are grouped into job dimensions. Measures may then be developed for each dimension. The critical incidents approach involves the following four steps:
selection tools
Information-gathering
methods used in
employee selection,
including application
forms, criminal records
checks, psychological
tests, interviews,
employment
verification, drug
screening, educational
background, reference
checks, verification
of professional
certifications, motor
vehicle records checks,
and credit history.
critical incidents
analysis
A process of generating
lists of good and
poor examples of
job performance and
translating them into
employee selection
criteria; this process
helps uncover
less formal—but
important—aspects of
performance.
DEBATE POINT
The idea of fit in hiring is important because it facilitates teamwork and positive work-
ing relationships. However, is there a risk that too much fit can be negative? If we only
want people in our organization who are like us, is there the possibility that the orga-
nization may become stagnant and miss opportunities for improvement? Furthermore,
can the idea of fit really be a disguise for simple prejudice bias? It has been suggested
that that cultural fit is “an incredibly vague term, often based on gut instinct. The big-
gest problem is that while we invoke cultural fit as a reason to hire someone, it is far
more common to use it to not hire someone” (Wharton School, University of Pennsyl-
vania 2015). Another writer noted that in many organizations, the idea of fit “has gone
rogue.” Interviews with 120 decision makers found that many were using subjective
personal criteria rather than screening for individuals who could succeed in the orga-
nization’ s culture (Rivera 2015). Furthermore, are there times when we may not want
fit to be an element in the hiring process—might we find it helpful to hire people who
specifically do not fit the culture of the organization? If so, under what circumstances
would this be desirable? Might too much fit also interfere with diversity goals for the
organization—are diversity and fit incompatible?
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1. Identify people knowledgeable about the job.
2. Generate critical incidents that represent positive and negative performance.
3. Identify key job dimensions based on these incidents.
4. Develop selection tools to assess applicants on these dimensions.
Exhibit 5.5 provides examples of three critical incidents and the job dimensions in which each incident is grouped. This exercise yields a thorough understanding of the job’s technical requirements, formal qualifications, and informal but critical aspects of success- ful performance.
r e f e r e n C e C h e C k s
Most organizations rely on certain sources for checking applicants’ background. These sources include information from references, criminal records, driving records, and credit checks. The usefulness of reference checks is questionable. Agreement among people who provide a reference for the same applicant may be low. This discrepancy may be explained by the reluctance to provide negative feedback and the possibility that raters may be evaluating different aspects of job performance. It is also not clear that information provided in refer- ences is predictive of future performance. The following explanations have been suggested for the poor predictive power of reference checks:
◆ Many measures used in reference checks have low reliability; where reliability is low, validity is also low.
◆ Individuals who provide references frequently only use a restricted range of scores—typically high—in evaluating applicants. If almost all reference checks are positive, they are likely to be poor predictors of job performance.
◆ In many instances, applicants preselect the people who provide the references and are highly likely to select only those who will provide a positive reference.
How can the validity and usefulness of reference checks be improved? Research in this area offers the following conclusions (Gatewood, Feild, and Barrick 2008):
◆ The most recent employer tends to provide the most accurate evaluation of an individual’s work.
◆ Reference givers are more likely to provide an honest assessment if they have had adequate time to observe the applicant.
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◆ References tend to be more valid if the applicant is the same gender, ethnicity, and nationality as the reference giver.
◆ Reference checks are likely to be valid when the old and new jobs are similar in content.
Job Critical Incident Job Dimensions
Physician, orthopedics department
In an administrative staff meeting to review plans for the coming year, this physician exhibited strongly conde- scending and rude behaviors toward other team members.
• Ability to work in teams • Respect for other
professionals
Nurse, emergency department
After a school bus accident, the emer- gency department was overwhelmed with children and frightened parents. This nurse effectively and appropriately managed communication with parents and obtained assistance from else- where in the hospital.
• Creativity and resourcefulness
• Leadership • Ability to work
effectively under crisis conditions
• Strong interpersonal skills
Medical director, public health department
The local media reported an outbreak of salmonella that resulted in one child being hospitalized. The outbreak was traced to a fast-food restaurant that had been inspected by health depart- ment personnel less than one week earlier. The health department was blamed for not preventing the out- break. This medical director conducted a thorough internal investigation and found that it was an isolated incident caused by mishandling of food on a single occasion. She communicated ef- fectively at a press conference, defend- ing the health department and assuring the public of the safety of local eating establishments.
• Effective crisis manager • Strong communication
and media skills • Strong sense of public
accountability
exhiBit 5.5 Critical Incidents Approach to Understanding Job Requirements
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Reference checks are widely used, but their usefulness is decreasing. Some organiza- tions advise their employees to provide only minimal information about former employees, such as job title and dates of employment, to reduce the liability of the referring organiza- tion to lawsuits from the hiring organization (through charges of negligent hiring) or the applicant (through claims of defamation of character). Exhibit 5.6 provides some basic guidelines for the appropriate use of references.
A less formal way to glean information about applicants is to take a look at them via social media, as many organizations are now doing (see “Did You Know?” sidebar).
DID YOU KNOW? Employers, Candidates, and the Internet
According to a CareerBuilder (2016) survey of 2,186 hiring managers, 60 percent of
employers reported that they use social media to research job candidates. Among
these hiring managers, 53 percent want to see whether the candidate has a profes-
sional online persona, 30 percent want to see what other people are posting about the
candidate, and 21 percent admit they’re looking for reasons not to hire the candidate.
Among the employers using social media, 49 percent indicated that they found
information that caused them to not hire a candidate. The top reasons are the following:
• Candidate posted provocative or inappropriate photographs, videos, or
information (46 percent)
• Candidate posted content about drinking or using drugs (43 percent)
• Candidate badmouthed a previous employer, coworkers, or clients (31 percent)
• Candidate showed poor communication skills (29 percent)
• Candidate made discriminatory comments related to race, religion, gender, etc.
(33 percent)
Yet among employers who used social media to screen applicants, 32 percent
found information that reflected positively on applicants, causing them to hire a candi-
date. The top positive reasons were the following:
• Candidate’s site conveyed a professional image (44 percent)
• Candidate’s personality came across as a good fit with company culture (43
percent)
• Candidate was well-rounded, showed a wide range of interests (40 percent)
• Candidate had great communication skills (36 percent)
Interestingly, 41 percent of employers indicated that they were less likely to hire
someone if no information at all was available online.
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j O B i n t e r v i e w s
A job interview is used for virtually all positions, largely because information from the application, references, and other documentation is usually incomplete. Interviews are sometimes given the greatest weight in hiring decisions but may present problems with reliability and validity, such as the following:
◆ Because applicants are not usually given interview questions in advance, they may not have the opportunity to prepare answers that would showcase their abilities.
◆ Questions may not be standardized, and interviewers might ask different questions of people applying for the same position.
◆ Where multiple interviewers are used, their questions, interview style, and interpretation and scoring of answers may vary.
◆ Untrained interviewers may ask questions that may lead to legal difficulties for the organization, such as inquiries about disabilities or plans for marriage or starting a family.
Even with these shortcomings, the interview can be an effective and efficient method of acquiring information about applicants (see “Critical Concept” sidebar on the next page). Furthermore, it can be a valuable recruitment tool because it allows the interviewer to highlight the positive features of the organization and the job.
Job interviews can be unstructured or structured. An unstructured interview is not standardized and has less formal structure. Unstructured interviews may be subjective and can be less reliable than structured interviews. However, their flexibility may help interviewers probe for unique information about applicants that may be overlooked using a structured interview format.
unstructured interview
An interview technique
in which questions
are usually open-
ended and guided by
applicant answers
and interviewer
preferences.
exhiBit 5.6 Guidelines for the Appropriate Use of Reference Checks
1. Ask for and obtain only job-related information. 2. Do not ask for information that may be deemed illegal. 3. Secure written permission from applicants to contact their references; this
permission may be included on the application form. 4. Make sure that individuals who check references are trained in how to interview
them, probe for additional information, and accurately record reference information.
5. Record reference information in writing. 6. Use the reference-checking process to confirm information provided by the
applicant and to identify gaps in the employment record. 7. Consider using preemployment information services, particularly for sensitive
positions.
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In a structured interview, questions are clearly job related and based on the results of a thorough job analysis (as described in chapter 4). Situational, behavioral, job-knowledge, and worker-requirement questions are most commonly posed during a structured interview.
A situational interview question asks applicants to describe how they would handle a hypothetical work scenario. A behavioral interview question asks candidates how they have previously handled a situation that is similar to a situation they may encounter on the job. Following is a scenario and related situational and behavioral questions. The applicant characteristics being assessed are the ability to handle a stressful situation, ability to deal appropriately with the public, and professionalism.
Scenario: Seven pediatricians work in a busy medical practice, and Monday morning is the busiest time of the week at the clinic. The waiting room is overcrowded, and two of the pediatricians are unexpectedly called away from the office—one to attend to a personal situation and the other to provide consultation for a hospitalized patient. Children and their parents now must wait up to two hours to see the remaining doctors, and their anger and frustration increase as they wait. They are taking out their anger on you, the clinic director.
structured interview
An interview technique
in which questions
and related constructs
(and sometimes,
preferred answers) are
developed in advance.
The same structured
interview is typically
used for all applicants
for a particular
position.
situational interview
question
A type of interview
question in which
applicants are asked
how they would handle
specific situations that
may arise on the job.
behavioral interview
question
A type of interview
question in which
applicants are asked
to relate how they
handled a specific type
of job situation in their
past experience.
CRITICAL CONCEPT A Successful Interview Process
The job interview is a common method of assessing applicants. To be used successfully,
interviews should
• focus on assessing applicants’ ability to carry out the essential functions of the
job;
• be planned in advance;
• use questions that all interviewers have agreed are important, relevant, and job-
related;
• not include questions that may lead to legal difficulties, such as inquiries
regarding religion or marital status;
• apply the same set of questions for all applicants for the same position;
• allow time for the interviewee to ask questions;
• include a planned time after each interview to score and assess applicants; and
• be conducted by individuals trained in interviewing techniques.
To be sure that interview questions obtain the information sought and are phrased
in an understandable manner, questions should optimally be pretested prior to their
use in an actual interview.
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Situational interview questions: How would you handle this situation? What and how would you communicate with the remaining physicians about this situation?
Behavioral interview questions: Think about a situation on your last job in which you were faced with upset patients or customers. What was the situation? What did you do? What was the outcome?
A job-knowledge interview question assesses whether applicants have the knowledge needed to do the job. For example, an applicant interviewing for the position of operating room nurse may be asked such questions as the following:
◆ What are three things you should always ask a patient before surgery?
◆ How would you prepare a patient for an appendectomy?
◆ How would you prepare the operating room for a patient with a latex allergy?
A worker-requirement interview question seeks to determine whether the candi- dates are able and willing to work under the specific conditions of the job. For example, applicants for a consulting position may be asked whether they are able and willing to travel for a designated portion of their work.
Whatever interview format is used, interviews must be conducted with the follow- ing guidelines in mind:
1. Prepare yourself in advance. For an unstructured interview, learn the job requirements so that you can formulate appropriate questions. For a structured interview, become familiar with the questions to be asked. Review materials or information about the applicant as well.
2. Before the interview, make sure that the physical environment in which the interview will take place is organized, clean, well lit, and a comfortable temperature.
3. As the interview begins, describe the job and invite questions about it.
4. Put the applicant at ease, and convey an interest in the person. A purposely stressful interview is not desirable, as other reliable and ethical methods can be used to assess an applicant’s ability to handle stress. A stressful interview reflects poorly on the organization.
5. Do not come to premature conclusions—positive or negative—about the applicant, particularly in unstructured interviews.
job-knowledge
interview question
A type of interview
question asked to
assess whether
applicants have the
knowledge needed to
do the job.
worker-requirement
interview question
A type of interview
question asked to
determine whether
applicants are able and
willing to work under
the specific conditions
of the job.
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6. Listen carefully, and ask for clarity if the applicant’s responses are vague.
7. Observe and take notes on relevant aspects of the applicant’s dress, mannerisms, and affect, such as motivation, attitude, expressed interest in the job, and comfort with the interview process.
8. Provide an opportunity for the applicant to ask questions throughout the interview, at the end, or both.
9. Do not talk excessively. Remember that an interview is an opportunity to hear from the applicant.
10. Do not ask questions that are unethical or that put the organization in a legally vulnerable position (see exhibit 5.7 and also refer to chapter 3).
11. Explain the selection process that comes after the interview. This explanation includes informing applicants when they should expect to receive the results of their job application and interview, how this information will be communicated, and the process by which applicants can inquire with questions about the job or the disposition of their application.
12. Evaluate the applicant as soon as possible after the interview.
a p p l i C at i O n s a n d r e s u m e s
Application forms and resumes contain useful information about applicants. The major drawback to these selection tools is that they may misrepresent an applicant’s qualifications. Resume inflation occurs when applicants misrepresent any aspect of their background or qualifications. Several methods can be used to improve the usefulness and quality of appli- cation forms. First, create an addendum to the application that asks applicants to provide information specific to the open position. Second, include a statement on the form that requires the applicant to indicate that all the information reported is accurate; the applicant should then be required to sign or initial this statement. Third, ensure that questions that may lead to legal difficulties (e.g., marital status, height, weight) are excluded from the form.
a B i l i t y a n d a p t i t u d e t e s t s
Some organizations use ability and aptitude tests that assess such applicant traits as per- sonality type, honesty, integrity, cognitive reasoning, and fine motor coordination. Organi- zations need to be sure that the traits measured in these tests are relevant to the particular job. Debate continues about the validity of many of these tests.
ability and aptitude
tests
A wide range of
employment tests that
evaluate applicants
along dimensions
relevant to the job; for
example, personality
type, honesty, integrity,
cognitive reasoning,
and fine motor
coordination.
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C h a p t e r 5 : R e c r u i t m e n t , S e l e c t i o n , a n d R e t e n t i o n 1 3 7
(continued)
Personal and Marital Status
Inappropriate Appropriate
How tall are you? (but acceptable if a safety requirement)
How much do you weigh? (but acceptable if a safety requirement)
Is this your maiden or married name?
Do you live alone or with someone else?
Do you smoke?
(When it is part of the job) Are you able to lift 50 pounds and carry it 20 yards?
Note: After hiring, inquiring about marital status for tax and insurance forms is allowed.
Parental Status and Family Responsibilities
Inappropriate Appropriate
Are you pregnant?
Do you plan to have children?
How many children do you have?
What are your childcare arrangements?
This job requires overtime occasionally. Would you be able and willing to work overtime as necessary?
Travel is an important part of this job. Would you be willing to travel as needed?
Would you be willing to relocate if necessary?
Note: After hiring, inquiring about dependent infor- mation for tax and insurance forms is allowed.
Age
Inappropriate Appropriate
How old are you?
In what year were you born?
When did you graduate from high school or college?
What year will you reach retirement age?
Do you meet the legal minimum age for the hours or working conditions of this position?
Note: This question may be asked to verify compli- ance with state or federal labor laws.
Note: After hiring, verifying legal minimum age with a birth certificate or other form of identification and asking for age on insurance forms are permissible.
National Origin
Inappropriate Appropriate
Where were you born?
Where are your parents from?
What is your heritage?
What is your native tongue?
What languages do you know? (too general to be appropriate)
Are you authorized to work in the United States?
May we verify that you are a legal US resident, or may we have a copy of your work visa status?
To meet the bilingual requirement as posted for this job, can you read, write, and speak Spanish fluently? (appropriate as relevant to the job)
exhiBit 5.7 Inappropriate and Appropriate Interview Questions
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Race or Skin Color
Inappropriate Appropriate
What is your racial background?
Are you a member of a minority group?
You look so tan. Have you been out in the sun?
This organization is an equal opportunity employer. Race is required information only for affirmative ac- tion programs. If you wish to be considered for these programs, will you tell me which racial category you identify with?
Religion or Creed
Inappropriate Appropriate
What religion do you follow?
Do you attend a house of worship regularly?
Which religious holidays would you need to be tak- ing off from work?
A lot of people in the department are Catholic. Are you?
What days are you available to work?
Are you able to work the hours of our required schedule?
Disability
Inappropriate Appropriate
Do you have any disabilities?
How does your condition affect your abilities?
Have you had recent illnesses or hospitalizations?
What is your medical history?
or Please fill out this medical history document.
When was your last physical exam?
Are you HIV-positive?
(When it is part of the job) Are you able to lift 50 pounds and carry it 20 yards?
(When it is part of the job) Are you able to kneel?
Are you able to perform the essential func- tions of this job with or without reasonable accommodations?
Note: After hiring, asking about the person’s medi- cal history on insurance forms is allowed.
Criminal Record
Inappropriate Appropriate
Have you ever been arrested?
Have you ever spent a night in jail?
Note: Questions about convictions by civil or military courts are appropriate if accompanied by a disclaim- er that the answers will not necessarily cause loss of job opportunity. Generally, employers can ask only about convictions and not arrests (except for jobs in law enforcement and security clearance) when the answers are relevant to job performance.
exhiBit 5.7 Inappropriate
and Appropriate Interview
Questions (continued)
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a s s e s s m e n t C e n t e r s
An assessment center is a multidimensional method of evaluating applicants. Applicants are assessed using various methods, including interviews, work simulations, leaderless group discussions, and role playing. Assessment centers set up situations wherein indi- viduals perform activities similar to those they may encounter in a job. Some companies establish assessment centers to determine how well current employees will handle new jobs or assignments.
re t e n t i O n The demand for healthcare workers is increasing and will continue for the foreseeable future. Among the most commonly cited reasons for this increased demand are population growth, the aging of the population, improved diagnostic techniques that enable earlier detection of disease, and heightened consumer demand for a full range of diagnostic and therapeutic technologies. Chronic workforce shortages will continue to characterize the health system, although the extent of many health workforce shortages varies by health profession and geographic factors.
Among the most critical employee group in the healthcare workforce is registered nurses. According to the Bureau of Labor Statistics’ employment projections for 2012 through 2022, the expected number of employed registered nurses will grow from 2.71 million nurses in 2012 to 3.24 million nurses in 2022, an increase of 526,800 nurses or 19.4 percent. These projections also explain the need for an additional 526,800 nurses to replace nurses leaving the workforce, bringing the total number of job openings for nurses
assessment center
Physical location where
testing is done, or a
series of assessment
procedures that
are administered,
professionally scored,
and reported to
hiring personnel, to
evaluate applicants
or assess employees’
developmental needs.
Affiliations
Inappropriate Appropriate
To what clubs or associations do you belong? Do you belong to any professional or trade groups or other organizations that you consider relevant to your ability to perform this job?
Note: Questions listed in this table are generally not illegal, with the exception of questions about disability status (illegal under the Americans with Disabilities Act as Amended). For example, it is not illegal to ask an applicant’s date of birth, but it is illegal to deny employment to an applicant solely because the person is 40 years of age or older—unless age is a bona fide occupational qualification. In this case, the question is not illegal, but a discriminatory motive for asking is illegal. An unknown or ambiguous motive is what makes any question with discriminatory implications inappropriate. If an individual is denied employment, having been asked such questions can lead the applicant to claim that the selection decision was made on the basis of age, gender, or another characteristic on which it is illegal to discriminate.
exhiBit 5.7 Inappropriate and Appropriate Interview Questions (continued)
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due to growth and replacement to more than 1.05 million by 2022 (Richards and Terkanian 2013). At the time of this writing, the nursing shortage at the national level has largely been erased. However, as Buerhaus and colleagues (2005) point out, nurs- ing labor markets are local and there will likely be considerable geographic variation in the extent to which the supply of nurses meets demand. They found that there is zero expected growth in the number of registered nurses per capita in New England and the Pacific regions between 2015 and 2030, while East South Central and West South Central regions are likely to experience up to a 40 percent growth in the supply of nurses per capita. Therefore, assuming increased demand for registered nurses, certain regions are likely to expe- rience shortfalls in the supply of nurses (Auerbach, Buerhaus, and Staiger 2017).
These broad societal factors are largely out of the control of individual healthcare organizations, and each organization has its own mission, service profile, and workforce requirements. Each organization also faces its unique external environment, reputation, labor market, and competitors. These local conditions, more than national trends, substantially influence workforce needs and worker vacancy rates. These vacancy rates, in turn, highlight the need for organizations to do a better job at recruiting, selecting, and retaining staff. In this section, we explain our concern with turnover, enumerate the costs associated with turnover, discuss the factors that contribute to turnover (see “Critical Concept” sidebar above), and explore the methods proven to improve retention. Although we use the nursing shortage as a basis to explore the turnover and retention issue, we are aware also of the shortages in other healthcare professions, such as among radiologic technicians, primary care physicians, and pharmacists. The lessons in our discussion, however, are applicable to other professions as well.
d i s t i n g u i s h i n g t u r n O v e r f r O m r e t e n t i O n
It is important to make a distinction between the separate, although related, concepts of turnover and retention. Many organizations view retention as the inverse of turnover and, as a result, miss out on critical trends that are happening within their systems. The turnover rate is a simple ratio that provides only a summary of the gross movement in and out of the organization during a specific time frame (usually one year). Rates may also be narrowed to certain types of turnover, such as voluntary turnover, or calculated for a
turnover
Employee departures
from an organization.
retention
Maintaining employee
employment with an
organization.
turnover rate
A ratio providing a
summary of the gross
movement in and out of
the organization during
a specific time frame.
CRITICAL CONCEPT Why People Leave Jobs
People leave jobs for many reasons. Some reasons may be
addressed by managers, while others may be out of manag-
ers’ control. Among the most common reason for people leav-
ing jobs is dissatisfaction with their supervisor. It is often said
that “people leave supervisors, not jobs.” Even with an effec-
tive retention program in place—including good pay—reten-
tion may be jeopardized by a rogue manager who alienates
employees through inappropriate behavior and interactions.
When designing a retention initiative, it is key to ensure that
supervisors exercise their authority and interact with staff
appropriately.
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particular department or discipline. The retention rate, on the other hand, is the percentage of specific individuals or cohorts that enter and exit the organization. The key distinction is that retention views an individual or a group as an entity; therefore, retention allows for a more thorough examination of how the loss of one individual or cohort influences retention strategies and productivity.
For example, an organization that experiences a slight decline in turnover (say, from 20 percent to 18 percent) over a five-year period may think that it is doing well in addressing its retention problem. However, during that same five-year time span, the retention rate of individuals who have between 5 and 15 years of service declined (say, from 70 percent to 35 percent). These rates may indicate that the organization has difficulty retaining experienced employees and needs to explore and implement new retention strategies. Alternatively, the organization may discover that while its turnover rate decreased, the retention rate among physical therapists dramatically declined. In other words, the overall turnover rate may mask severe retention problems. Overall, organizations need to thoroughly examine both turnover and retention rates to successfully deal with the challenge of staff shortages.
In examining nurse turnover, researchers have sought to understand the trends in turnover as well as the factors associated with turnover. The demand for healthcare workers has increased, but the quality of their work life has decreased. The average annual turnover rate for nurses is about 17.1 percent, with substantially higher percentages for particular professional groups. Nurses working in pediatrics experience the lowest rate (11.7 percent), while nurses in behavioral health (26.5 percent), emergency (21.1 percent), and medical/ surgical (20.4 percent) experience the highest; certified nursing assistant turnover also is among the highest, at 23.8 percent (Nursing Solutions 2016).
Particularly worrisome to many nurse leaders is the disturbingly high rate of turnover of newly licensed registered nurses (RNs). A study that has received a great deal of attention found that 17.5 percent of newly licensed RNs leave their first nursing job in the first year, and one-third leave within two years (Kovner et al. 2014). This statistic has drawn atten- tion to the need for careful attention to assessing work environments, measuring turnover, and onboarding processes.
Also of concern is the turnover rate among hospital bedside registered nurses. Illus- trative of the variation among hospitals in turnover, the overall turnover rate for bedside RNs averages out to 17.2 percent, but actual turnover ranges from 8.8 to 37.0 percent. Turnover certainly affects patient care, but it also represents a significant cost to hospitals. It is estimated that a mere 1 percent increase in the RN turnover rate translates into an average hospital cost of $373,200 (Nursing Solutions 2016).
Compared to hospitals, nursing homes face exceedingly high levels of nursing turn- over. Information from the American Health Care Association (AHCA) revealed a median turnover rate of 43.9 percent among all employees in skilled nursing care centers in the United States in 2012. Among RNs, the turnover rate was an alarming 50 percent. Among direct care staff, certified nursing assistants had the largest mean turnover rate at 51.5 percent;
retention rate
The percentage of
specific individuals or
cohorts that enter and
exit the organization.
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licensed practical nurses (LPNs) and licensed vocational nurses (LVNs) experienced the lowest median turnover rate at 36.4 percent (AHCA 2014). A lack of direct care workers to staff nursing homes in one California county threatened to lead to a reduction in beds or even facility closure (Houston 2016). The situation is similarly challenging for home care agencies, where a 2017 survey of private home care agencies found that 76.8 percent of respondents identified caregiver shortages as a major impediment to growth. This is an increase from 62.8 percent in 2015 and 69.7 percent in 2016 (Home Care Pulse 2017).
s t u d i e s O n n u r s i n g t u r n O v e r
Dissatisfaction has been cited as a key reason for turnover and departure from the nursing profession in the twenty-first century. In a worldwide study, nurses surveyed in the United States had the highest rate of job dissatisfaction—41 percent, four times higher than the dissatisfaction score of the professional workforce in general (Aiken et al. 2001; Albaugh 2003). Oft-cited reasons for dissatisfaction include work schedules; lack of opportunities for advancement; work environment; lack of independence at work; inadequate wages; issues associated with professional status; poor, unresponsive, and unsupportive management; work overload; high patient-to-nurse ratios; inadequate staffing; and lack of respect and appreciation from management (McHugh et al. 2011; Vaidya 2013). The Maryland Nurses
Association (2000) articulated its top five reasons for poor nurse retention: (1) absence of advance- ment opportunities, (2) stress and burnout related to mandatory overtime, (3) unrealistic workloads, (4) increased paperwork, and (5) nurse perception of lack of respect and recognition in the workplace. (For another organization’s top 10 reasons for nurse turnover, see the “Did You Know?” sidebar.) The Joint Commission (2004) found required overtime to be a major source of dissatisfaction. A survey conducted by Medscape (Peckham 2015) found that while a substantial proportion of nurses had regrets about their choice of profession, 60 percent of APNs, 56 percent of RNs, and 48 percent of LPNs would choose their profession again.
Turnover has an adverse effect on organiza- tional performance and quality of care. Numerous studies have documented the relationship between a shortage of registered nurses, increased nurse workload, and quality of care (Cimiotti et al. 2012; Needleman et al. 2011; Tubbs-Cooley et al. 2013). Nurses tend to agree that shortages affect
DID YOU KNOW? Top 10 Reasons for Nurse Turnover
A survey of 96 healthcare executives, representing hospitals,
long-term acute care, and other healthcare organizations,
found the following top 10 factors associated with nurse turn-
over (Nursefinders 2005):
1. Work-related stress (57 percent)
2. Patient care load/staffing (56 percent)
3. Effectiveness of direct manager (53 percent)
4. Scheduling options (51 percent)
5. Recognition (51 percent)
6. Compensation (41 percent)
7. Participation in decision making (33 percent)
8. Competence of clinical staff (31 percent)
9. Growth opportunities (24 percent)
10. Ancillary support personnel (22 percent)
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the quality of care. Buerhaus and colleagues (2005) found that three-quarters of RNs believe that nursing shortages lead to problems in the quality of care, quality of their work lives, and the amount of time nurses can spend with patients. These concerns have been present among nurses for many years. An earlier well-cited survey conducted by the American Nurses Association (ANA 2001) found that 75 percent of nurses felt that the quality of nursing care had declined. Among respondents who claimed that quality has suffered, more than 92 percent cited inadequate staffing as the reason, and 80 percent indicated nurse dissatisfac- tion. The ANA survey also reported that more than 54 percent of respondents would not recommend the profession to their children or friends. Confirming evidence from earlier studies, Aiken and colleagues (2001) argued that low nurse-to-patient ratios are strongly related to higher levels of dissatisfaction and emotional exhaustion. These studies highlight the connections among nurse dissatisfaction, turnover, and quality of care.
In addition to their effect on quality, shortages and turnover also have significant financial implications. The costs associated with employee termination, recruitment, selec- tion, hiring, and training are substantial. A study funded by the Robert Wood Johnson Foundation found that the cost of replacing a registered nurse ranges from about $22,000 to more than $64,000; these expenses are associated with filling temporary vacancies and hiring and training new staff (Lewin Group 2009). For further information on the cost of nurse turnover, see the “Current Issue” sidebar.
CURRENT ISSUE The Cost of Nurse Turnover
While difficult to measure, the Advisory Board Company (1999) and Jones (2005) have
attempted to capture the direct costs of nurse turnover and the hidden costs of re-
duced productivity. The estimated cost of a single nurse leaving is $42,000 (per the
Advisory Board) to $64,000 (per Jones), and these estimates support the claim that
nursing turnover has significant financial implications for all healthcare organizations.
Assuming a turnover rate of 20 percent and a cost of nurse turnover ranging between
$42,000 and $64,000 per nurse, a hospital that employs 600 nurses would face yearly
estimated nursing staff replacement costs of between $5 million and $7 million. For an
excellent review of multiple studies that have attempted to assess nursing costs, see
Y. Li and Jones (2013). They conclude that variations in estimating the cost of turnover
are related to differences in how turnover is conceptualized and measured, diverse ap-
proaches to gathering data and data sources, inconsistencies in the conceptualization
and measurement of nurse turnover and turnover rates, the variations in the methods
used for gathering data and the data sources used, and differences in how turnover
costs are calculated.
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r e t e n t i O n s t r at e g i e s
Many of the factors associated with effective recruitment are also applicable to retention because a person’s reasons for accepting an employment offer and staying with that employer are often similar. Retention strategies are a necessary follow-up to recruitment. With the opportunities available to nurses in other organizations and work roles, retention strategies are as essential as compensation and training.
Organizations can somewhat control turnover, but their influence is limited. The market profoundly affects the movement of employees, and retention strategies have not achieved the consistent success once anticipated. Each organization needs to develop its own retention strategies and tailor them to the particular circumstances of the institution.
Several generic retention strategies have proved effective:
◆ Selecting the right employees.
◆ Improving orientation and onboarding processes by creating a buddy program and otherwise helping new employees establish professional and personal relationships with colleagues.
◆ Offering competitive compensation. Compensation comes in many forms, including signing bonuses, premium and differential pay, forgivable loans, bonuses during employment, and extensive benefits.
◆ Structuring jobs so that they are more appealing and satisfying by carefully assign- ing and grouping tasks, providing employees with sufficient autonomy, allowing flexible work hours and scheduling, enhancing the collegiality of the work envi- ronment, and instituting work policies that are respectful of individual needs.
◆ Putting in place a strong management and supervisory team. The idea that people quit their supervisors, not their jobs, is true in nursing, as nurses sometimes leave because of poor working relationships with their managers or other healthcare professionals.
◆ Making opportunities for career growth available.
◆ Providing adequate staffing to control patient care workloads.
◆ Monitoring turnover to identify specific root causes, including identifying managers whose departments have high turnover rates.
◆ Developing and implementing ways to retain valued employees.
◆ Attempting to reverse a nurse’s decision to leave an organization.
An evidence-based protocol was developed that identifies key factors related to decreasing turnover (Gess, Manojlovic, and Warner 2008). This protocol emphasizes
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approaches that improve organizational commitment among nurses, focusing on facilitat- ing autonomy, improving communication, and offering rewards and recognition to nursing staff. Specific retention goals include encouraging staff members to seek learning experi- ences, encouraging and supporting creative freedom in practice, supporting a participative management structure with shared governance, acknowledging work and providing posi- tive feedback, listening to what nurses are saying about patient care, implementing shared governance models, and increasing communication. The American Nurses Credentialing Center (ANCC) established the Magnet Recognition Program to acknowledge and reward healthcare organizations that exhibit and provide excellent nursing care. Designated Magnet hospitals are characterized by fewer hierarchical structures, decentralized decision making, flexibility in scheduling, positive nurse–physician relationships, and nursing leadership that supports and invests in nurses’ career development (ANCC 2017a). Magnet hospitals have been found to have better patient outcomes and higher levels of patient satisfaction (McHugh et al. 2011). Compared to other hospitals, Magnet institutions have lower turnover and higher job satisfaction among nurses (Huerta 2003; Upenieks 2002). These findings suggest that becoming a Magnet healthcare organization has the potential to increase nurse satisfaction and improve retention (Drenkard 2010).
i n t e r n at i O n a l r e C r u i t m e n t a n d m i g r at i O n
Recruiting health professionals from other coun- tries can help address the US health workforce shortage. In the United States, about 25 percent of physicians were born and educated in other countries, and about 4 percent of nurses were edu- cated overseas (Aiken et al. 2004; Cooper and Aiken 2006). Because of demand for their skills, US physicians and nurses have had opportuni- ties to seek employment internationally since the late twentieth century, and professionals trained abroad are important parts of healthcare systems in many countries (see “Current Issue” sidebar on “push and pull factors” that influence migration of physicians and nurses).
The implications of international migration of physicians and nurses are a source of increasing debate. While physicians and nurses who migrate to other countries can benefit from better work- ing conditions or salaries in their destinations, their movement can exacerbate inequalities in the
Magnet Recognition
Program
A program established
by the American
Nurses Credentialing
Center to acknowledge
and reward healthcare
organizations that
exhibit and provide
excellent nursing care.
CURRENT ISSUE Push and Pull Factors in Physician and Nurse Migration
Physician and nurse migration are often discussed in terms of
push and pull factors. Push factors motivate physicians and
nurses to leave their home countries, while pull factors cause
them to choose particular receiving countries.
Push factors include low compensation, poor working
conditions, political instability and insecurity, inadequate
housing and social services, and lack of educational oppor-
tunities and professional development.
Pull factors include opportunities for professional train-
ing and career advancement, personal development, better
job opportunities, a stable political environment, and higher
wages.
Source: Li, Nie, and Li (2014).
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worldwide distribution of healthcare workers. Developing countries whose citizen doctors leave lose their investments in education and training, income tax revenue, and potential for national growth, and their population’s health may be adversely affected. In nations where healthcare workforce shortages are already severe, the need to replace professionals who emigrate depletes the system’s resources, claiming funds that normally go toward fight- ing diseases and promoting public health. These factors only worsen existing healthcare disparities between developed and developing countries.
Recruitment of workers from abroad has important ethical implications, but thus far there has been little guidance for developing appropriate policies. An exception is the United Kingdom, which is one of the few major receiving countries to develop a specific policy to guide the recruitment of internationally trained physicians and nurses. Its National Health Service (NHS) has created the Code of Practice on International Recruitment, which includes the following provisions (Buchan 2007):
◆ Developing countries should not be targeted for active recruitment by the NHS unless the government of that country formally agrees.
◆ NHS employers should use only recruitment agencies that have agreed to comply with the Code of Practice.
◆ NHS employers should consider regional collaboration in international recruitment activities.
◆ Staff recruited from abroad should have the same legal protections as other employees.
◆ Staff recruited from abroad should have the same access to further training as other employees.
The movement of international medical and nursing graduates into the US healthcare system raises several important issues for managers and leaders. Managers must be aware of issues of ethical recruitment, regulation and visas, credentialing, and adaptation. All these areas must be considered to maximize the success of recruitment and incorporation of international professionals and minimize migration’s negative effects on sending countries.
Recruiting, selecting, and retaining employees continue to be important HRM functions, especially in such a competitive, pressurized environment as healthcare. Healthcare orga- nizations and their HR departments face enormous challenges. They need to seek employees who (1) have specialized skills but are flexible enough to fill in for other positions, (2) bring
s u m m a r y
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in expertise and are able to work in groups whose members are not all experts, (3) are strongly motivated yet comfortable with relatively flat organizational structures in which traditional upward mobility may be difficult, and (4) represent diversity yet also fit into the organizational culture. HR professionals need to develop innovative strategies to improve retention.
1. Given two equally qualified applicants—one from inside and one from outside the organization—how would you decide which one to hire?
2. Some healthcare organizations are unable to pay market rates for certain positions. What advice would you give such an organization about possible recruitment and retention strategies?
3. The use of work references is increasingly viewed as unreliable. How can employ- ers legally and ethically obtain information about an applicant’s past performance? What measures can be taken to verify information contained in a job application or resume?
4. What are the advantages and disadvantages of recruiting through the Internet? What advice would you give to a hospital that is considering using the Internet for recruitment?
5. It has often been stated that “people do not leave jobs; they leave supervisors.” What does this statement mean, and why is it important?
ex e r C i s e 1 Note: This case was developed in collaboration with Caroline LeGarde Shafa, Vice President, Operations, Sibley Memorial Hospital, Washington, DC.
Grayson County Regional Health Center is a private, not-for-profit, 225-bed acute care hospital located in a rural community in a southeastern state. The hospital provides a broad range of inpatient and outpatient services, including cardiology, obstetrics, gynecology, general surgery, internal medicine, urology, family medicine, dermatology, pediatrics, psychiatry, radiology, nephrology, ophthalmology, occupational medicine, and rehabilitation services. The center offers 24-hour emergency care. The center is built on a 96-acre site, and its service area includes Grayson County and parts of three neighboring rural counties.
In the last 20 years, the region has suffered severe economic setbacks. Most of the textile industry has moved out of the region because of outsourcing, and the town itself has fallen into disrepair. An increasing proportion of the population—33 percent of children
f O r d i s C u s s i O n
e x p e r i e n t i a l e x e r C i s e s
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and 22 percent of the elderly—lives below the poverty line. The county has a civilian labor force of 27,568 and currently has an unemployment rate of 13 percent. The county’s infant mortality rate is 2 percent.
The center has 85 physicians, representing 29 subspecialties, on staff. It has affili- ation relationships with two academic health centers—one about 90 miles away, and the other 100 miles away. The center employs more than 800 people, is fully accredited by The Joint Commission, and is certified to participate in Centers for Medicare & Medicaid Services (CMS) programs. The center is governed by an 18-member board of trustees, which includes the chief of the medical staff, the immediate past chief of the medical staff, the chief execu- tive officer, and 13 members selected by the board from the community at large.
The center has strong community ties. Its staff members participate in community health screenings, health education programs, and health fairs. It serves as the meeting place for many support groups. Although it has been under financial stress for the last five years, it continues to have strong support in the community.
The employee turnover rate at the center is 40 percent. Over the last few years, the turnover rate for nurses has ranged from 15 to 50 percent. Physician recruitment and reten- tion are also major concerns. Currently, only one radiologist is practicing in Grayson County, and there is a shortage of physicians in all specialties.
The center relies heavily on Medicaid and Medicare revenue, leaving the hospital in a difficult financial condition. It is unable to pay market rates for nurses and other profession- als, so nursing units are understaffed and nurses feel overworked and underpaid. The quality of patient care may also be decreasing. A local newspaper article reported that patients at the center were often left on stretchers in the hallway for long periods, staff members were unresponsive to patient and family concerns, and crying in the hallways is not unusual.
Nurses and other professional groups report poor communication between senior management and employees. Bad relationships between middle managers and frontline staff are also a problem in some departments. This situation became particularly difficult two years ago when the center embarked on a large building project. Employees could not understand how the center could afford to build new facilities but was unable to pay market rates to its staff.
The nursing turnover problem at the center has reached crisis proportions. Recent exit interview surveys indicate that financial concerns are the major reason for leaving. The center has tried numerous strategies, including improving the work environment by adding amenities (such as lower prices in the cafeteria) and training middle managers. For a short time 18 months ago, nurse salaries matched market rates, but the center fell behind again shortly thereafter. The RN vacancy rate currently is 18 percent.
As a consultant to the center, you are expected to make recommendations to address the nursing shortage. Specifically, you have been asked to develop short-term strategies to cope with the current crisis and long-term strategies to improve the overall recruitment and retention picture. Consider the following questions:
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C h a p t e r 5 : R e c r u i t m e n t , S e l e c t i o n , a n d R e t e n t i o n 1 4 9
• How will you identify the most important reasons for the current shortage? • How will you develop short-term and long-term strategies?
ex e r C i s e 2 What do you look for in a job? In considering a job offer, you may feel that there is something lacking in person–organization fit. In a group, consider the following questions:
1. What do you look for in an organization, besides a job for which you are qualified and that provides an acceptable level of compensation and benefits?
2. What aspects of an organization might make you consider turning down an other- wise good job offer?
3. What is meant by organizational culture and why does it play a role in the employee selection process?
4. When considering a job offer, people often look at organizational culture to see if it is consistent with their own values. How do you find out about the culture of an organization?
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