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Why a good hire goes bad

Situation County Hospital, a rural 25-bed, critical access hospital, posts a need for an Emergency Room nurse to work nights. A nationally recognized staffing agency identifies Jane Doe as “the perfect” candidate. She is “highly over-qualified” because she has worked in large teaching hospitals, where she has seen and done most everything. Additionally, Jane has worked more than 15 assignments, without issue, in the past. Jane is submitted to the posting and scheduled for an interview. The hospital is impressed with Jane’s experience and is convinced she will be a good fit. An assignment is offered, and Jane accepts.

Fast forward 2 weeks after start date. The staffing agency has received multiple complaints from Jane regarding her new assignment. Jane worries that unsafe practices are being performed, saying she has limited resources, inadequate supplies and specialists who are on-call, not on site. She also is having to handle her own trach care, insert her own Foley catheters and perform other duties she generally has not been required to do. Jane worries that her license is in jeopardy, something that has never been a concern in all her years of nursing prior to this assignment.

Likewise, the hospital has made numerous complaints regarding Jane’s performance. Her manager states she is not competent and does not live up to her skills checklist. Specifically, the manager says Jane isn’t comfortable with trach care, chest tubes or performing her own nebulized treatments. Additionally, Jane frequently complains of being short staffed, not having techs available and having to transport her own patients. Despite having many conversations with Jane and extending her orientation, the hospital has decided that she just isn’t a good fit and terminates the contract.

What went wrong?
Jane was an extremely competent nurse who was erroneously submitted (by the agency) and accepted (by the facility) due to her extensive experience in large teaching facilities. Neither the agency nor the hospital considered the resource and cultural differences between large and small hospitals,or recognized the knowledge and comfort gap that would create for Jane. Was Jane a dangerous and incompetent nurse? No. Was County Hospital a dangerous facility? No. Jane was just not the right candidate for this particular assignment.

How can the same problem be avoided in the future?
Understanding the culture of a hospital/unit and comparing it with your candidate is paramount in ensuring a good fit, great care and an enjoyable experience for all involved.

Here are five recommendations to help avoid a bad fit.

  1. Agencies should really get to know the hospitals and units they work with. Understand the culture, expectations and reality.
  2.  Vet both the candidate and the facility, looking for similarities in previous assignments. Don’t assume “if she can work there, she can work anywhere.”
  3. Ensure the candidate understands the importance of the skills checklist and being honest about their comfort level with each skill. Encourage candidates to think about whether they could independently perform said skills, if no one else was around to help.
  4. Hospitals should offer candidates an opportunity to tour the unit to see firsthand how staff members perform their jobs or, if a tour isn’t possible, provide a “day in the life of” summary of the unit. Offer candid information and experiences about the unit.
  5. Candidates should be active participants in interviews, asking questions to be sure they understand the daily routine and expectations. Ask about coverage at night, on weekends and holidays, if ancillary staff is used and available, as well as other unlicensed staff.