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Setting your standards high

Murray, Kathleen MSN, RN, CNA

doi: 10.1097/01.NUMA.0000424020.90916.35
Department: Leadership Q&A

Chief Nurse Executive, Baptist Medical Center Beaches, Jacksonville, Fla.

Q I have a marginally performing team member who was hired 60 days ago. Our policy is that the employee stays on probation for 90 days. Would you keep the employee or would you terminate him or her?

A problem that many organizations face is that avoidable turnover, on average, costs an organization approximately 50% of an hourly employee's salary. As a leader in recruitment and the selection of the right talent, you need to invest up front in the selection process. For example:

  • Have you established what experience and credentials are required for the position?
  • What are the competencies and skill set needed for the position?
  • Are you using behavioral-based questions and including key stakeholders in the interviewing process?
  • During the interview process, were you able to assess the employee's attitude and work style?
  • Do you have an onboarding structure that includes a 30-day check-in with the manager, a 60-day check-in with the director, and a 90-day check-in with senior leadership?
  • During the 30-, 60-, and 90-day check-ins, did leadership review with the employee any performance issues and provide an action plan for how the employee could improve?


If it's evident that the employee isn't working out after you've clearly provided regular feedback and documented any performance issues, you should proceed and terminate him or her before the end of the 90-day probationary period. Sometimes, no matter how hard you try to onboard them successfully, new hires may be in the wrong job. It's essential that you identify the type of position a potential employee can excel at based on his or her skill set and passion.

As a final point, you need to treat the termination of a new hire in the 90-day probationary period as you would a negative outcome on your unit by completing an in-depth analysis of why it wasn't a successful hire. As the leader who hired the employee, if it was a poor hiring decision to begin with, utilize lessons learned to hire better the next time.

Q We've definitely noticed that patient satisfaction scores are much higher for private room floors than those with semiprivate rooms. Why doesn't the Centers for Medicare and Medicaid Services take this into account?

The dilemma of private rooms versus semiprivate rooms and the impact on patient satisfaction outcomes is an ongoing challenge for many facilities. Often, patients and families will overlook amenities if they feel they've connected emotionally during every staff encounter at your facility.

It clearly starts at the top to align the culture of the organization to a “patient-centric” environment. The message that needs to be communicated is that everyone within the organization owns a part of the patient experience. Your role is to make sure you're clear about what needs to be focused on to impact the following key drivers of the Hospital Consumer Assessment of Healthcare Provider and Systems domains: nurse communication, physician communication, hospital staff responsiveness, pain management, medication education and explanations, hospital cleanliness and quiet at night, discharge information, and overall hospital rating of care.

I would recommend that you follow several patients admitted to your unit from the ED through discharge to identify necessary process improvements. Examples of best-practice initiatives to improve the patient experience include hourly rounding, nurse-physician rounding, discharge phone calls, standardization of medication information, and bedside shift report. After you've implemented and hardwired the evidence-based initiatives based on your assessment, you'll need to ensure that staff members are supportive and engaged. If your staff isn't functioning with a team approach to the delivery of patient care, your patients and families will be able to sense the disconnect immediately.

It's important that your staff members clearly understand their role in providing the kind of hospital experience that patients and families will embrace. As a leader, you'll need to set the standard that your unit will exceed patient and family expectations during every healthcare encounter.

© 2013 by Lippincott Williams & Wilkins, Inc.