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Does your applicant have what it takes for continuing care?

April 2, 2015
by Frederick P. Morgeson, PhD
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A behavioral assessment could help you find out
Frederick Morgeson, PhD

Let’s be honest. Hiring and retaining employees is more challenging in continuing care than in other segments of the healthcare industry. Working with patients/residents and their families is fulfilling, but it also is physically and emotionally demanding. Employees who thrive in this environment require a different mix of skills and behavioral competencies than individuals who work in acute care settings.

Unfortunately, most continuing care organizations have not found ways to identify applicants who have these skills and who will “fit” within the organizational culture. The result is high turnover and poor employee retention. Consider the facts:

  • A study of nine long-term care facilities found that turnover ranged between 28 percent and 115 percent, with an average of 66 percent
  • The national median tenure rate across all jobs in the United States is 4.4 years, according to one white paper [PDF]. The median tenure rate for registered nurses (RNs) in home healthcare services is 1.17 years, however, and in nursing care facilities, it’s 0.97 years.
  • According to the U.S. Bureau of Labor Statistics, high levels of employment growth are projected for nursing care facilities. This growth will result in more competition for talent, and retention will become an even greater issue for continuing care organizations.

And turnover is expensive. Replacement cost estimates vary widely—for example, ranging from $36,500 to $44,000 for RNs, according to two studies (find one here and the other here) to $64,000 for specialty nurses, according to another study, and those figures are per departure. Of course, these estimates depend on numerous factors, but if we conservatively assume that each nurse turnover costs $30,000 and an organization has 150 nurses and a 25 percent turnover rate (low, by the way, for continuing care), then the estimated cost of turnover is $1.125 million per year. Further, it has been estimated that for every one percent increase in annual nurse turnover, the average facility loses $300,000 per year, according to one white paper. Or, thinking of it the other way, for every one percent reduction in turnover, a typical facility will save $300,000 per year. Even small decreases in turnover, therefore, can result in big savings.

Screening applicants

Finding the right applicants before making an employment offer is a proven way for continuing care organizations to improve employee retention and lower the costs associated with turnover. Measurements of variability in applicant capabilities and tendencies during the hiring process can be used to hire applicants who will perform better on the job, deliver higher-quality resident care and be more compatible with the organizational culture. When hired applicants are a better fit for the job and organization, they are more likely to remain with the organization over the long term.

Behavioral assessments conducted before hiring can effectively measure the underlying behavioral competencies  predictive of performance, compassion and likelihood that an individual will remain with an organization. Assessments that collect two types of information can help predict retention.

  • Biographical data, or biodata, reflect information about past behaviors, life experiences and feelings about specific situations. Biodata can tell us how embedded an applicant has been at previous employers as well as their habitual commitment level. An example of a question that assesses habitual commitment: “How many months did you work at your last job?” All else equal, applicants with a longer work history have a tendency to work longer at subsequent jobs.
  • Personality data. This information sheds light on stable individual characteristics, including behavioral tendencies oriented toward staying or leaving a job. An example of a question that assesses emotional stability: “Do you become irritated when others criticize you?” Continuing care work can be stressful, and emotionally stable applicants are better able to manage the inevitable stresses that will arise on the job, leading to greater retention and lower turnover.

To obtain optimal results with behavioral assessments, use three best practices: