Secondary Logo

Recruitment and retention: How to get them and how to keep them

Cohen, Shelley MSN, RN, CEN

Nursing Management (Springhouse): April 2013 - Volume 44 - Issue 4 - p 11–14
doi: 10.1097/
Department: NEW Manager Matters

Shelley Cohen is an educator and healthcare consultant in Hohenwald, Tenn.

The author has disclosed that she has no financial relationships related to this article.

As a new manager, you find your ever-evolving role and responsibilities hanging over the dangling schedule. Ensuring appropriate staffing is essential for safe and efficient patient care, as well as a healthy work environment. As straightforward as this may sound, the challenging realities of posting a time sheet result in a large amount of time and effort to ensure “holes” in the schedule are filled. These challenges arise from common scenarios, such as:

  • vacation time
  • sick time
  • jury duty
  • family leave
  • staff members leaving their positions
  • injured staff members who are unable to perform their jobs
  • difficulty filling vacant positions.


Part of your ability to handle and respond to challenges such as these is to recognize what you can and can't control. You should also recognize opportunities in areas where you can be proactive. If you direct your attention to these areas, recruitment and retention come to the forefront. For example, you can't control a staff member who's moving out of state to be closer to his or her family. On the other hand, you do have some control in offering learning opportunities for staff and enhancing a healthy work environment by mentoring professional practice. (See Table 1.)

Table 1

Table 1

Back to Top | Article Outline

Prep for every interview

Recruitment efforts can be costly, time-consuming, and deliver poor results if the interviewing element isn't well planned. Make the most out of recruitment efforts by developing a packet of interest that can be sent to the prospective hire before the interview date. If you're in a position where you're interviewing people with no advance notice, provide the packet in a room where they can review the material before your meeting. The packet should include the following:

  • your business card
  • the organizational mission/vision statement
  • the job description for the applicant
  • departmental/team goals (if you have these developed)
  • an introductory generic letter that highlights your expectations of staff.

Your welcoming remarks during the interview should quickly turn to the content of the packet by asking key questions, such as:

  • How does the job description you reviewed compare with your current job? What would be expected of you here that you currently aren't doing?
  • What do you think of our mission? Can you give me an example of how you'd apply these principles in your daily practice?
  • Our staff worked hard on developing a set of team goals and feel they're the reason behind why we have such little turnover. How do you see yourself fitting in to these goals? Tell me one or two things you do in your daily practice that demonstrates the importance of a team concept.

Be cautious in your interview; a common error new managers make is focusing on skills and experience in the specialty/role for which the applicant is applying. Although clinical skills and practice are certainly important, remember you can always train new hires in many of these tasks. On the other hand, there's no training to make a person compassionate, demonstrate ethical practice, or have the character one would want in a colleague. These traits and attributes come with the person—they're part of the whole package you're hiring. Contacting previous employers won't typically provide these details about a person; however, some will tell you whether the person can or should be rehired.

Back to Top | Article Outline

Look for character

How, then, does a manager assess character during an interview process? Authors Gostcik and Elton recommend thinking in terms of “trustworthiness.”1 Although most healthcare organizations perform background checks on prospective employees, those details don't always reveal all elements related to trust. Consider including one or two questions in your interview process that raise concern for trust:

  1. Tell me about a time when you were asked to compromise your values as a healthcare worker.
  2. What would you do if you saw a nurse or physician do something illegal?

Another consideration is related to including select staff in the interviewing process.1 This is most successful when the manager educates and guides staff on interviewing techniques. Be alert to the fact that many staff members won't have knowledge of federal laws related to hiring, application questions, and so on. For example, it's not acceptable to ask an overtly pregnant woman when her baby is due or to ask a prospective employee if he or she will have trouble showing up for a shift because of childcare obligations. Involve your human resources representative in this learning process for both yourself and staff members who'll partake in the interview process.

The person you hire isn't going to be working by your side during his or her shift, so engaging staff members (that he or she will work with) in the interview process is essential. Allowing staff members to interview prospective employees can prove very beneficial in weeding out potential hires who don't fit the culture of the department. In addition, this process sends a message to staff members that their opinions are important and that you as the manager recognize the vital role they play in the department and interview process.

When the interview content shifts to the clinical arena, preplan your questions and be sure to ask questions that are specific to the job for which the applicant is applying. Determine methods to help validate the questions' content before the hiring process. There are a variety of methods a manager can utilize for this process, including requiring current specific certifications, using patient-case scenarios in the interview to assess the knowledge level, and reviewing clinical questions that staff can submit for your review and approval. Below are two examples, one of which is directed to a licensed staff applicant and the other for an unlicensed applicant.

1. Direct care nurse:

As you know from reading the job description, one of your roles would be to perform triage in our ED. What national standard for scoring does your current employer use? Share with me how you believe this helps in the sorting process of patients.

2. Unlicensed assistive personnel:

I see from your résumé that one of the skills you perform at your current job is to obtain 12-lead ECGs. Where were you taught to place the chest leads?

As you know, our technicians on the orthopedic floor apply splints, and I see in your application that you noted this to be one of your skills. Share with me the steps you were taught to apply a sugar-tong splint.

Back to Top | Article Outline

You've got what?

Before you give yourself a high five for an effective hiring process, your attention needs to turn to how you're going to retain these employees. A commonly overlooked partner to recruitment, retention has recently gotten a long overdue priority mark from many healthcare organizations. Several articles and books have estimated the cost of turnover ranging from over $40,000 to $80,000 for a new graduate nurse to $40,000 or more per nurse.2,3 Renowned nurse researcher Dr. Linda Aiken reveals, “it costs approximately the annual salary of the lost nurse to find a permanent replacement, taking into account recruitment costs, supplemental staffing to fill the vacancy temporarily, and overtime to the other nurse to cover the position.”4

As you research and gather information about retention strategies and techniques, consider the financial checks and balances. Are you challenged with funding approval for an educational activity, specialty library for staff, certification pins/plaques, and so on? If so, it may be helpful to develop a retention budget planning worksheet. As you cumulate these costs, submit the data to your manager along with actual turnover costs for your department. Anticipate questions you'll be challenged with, such as, how will you know your strategies are successful? Measuring this success is integral to your continuing ability to be budgeted for these funds, but also to move toward raising the allotted funds each year. Options for validating success with your retention strategies include tracking actual turnover, posting and circulating the data, and surveying staff before the implementation of a retention program.

Survey questions should focus on items that will help direct your retention efforts, such as determining what areas of employment are important to staff. Ongoing education, recognition programs, advanced skill opportunities, leadership development, and nursing research are examples of elements to include in your survey process. During this process, be sure to:

  • survey staff after implementation of the program and compare results
  • compare your turnover rates with other departments
  • compare staff satisfaction results with patient satisfaction scores.

Note that a multitude of resources are available to assist you with planning for retention goals and strategies. Aside from blogs, e-books, and web articles, there are targeted resources, such as those written by Dr. Bob Nelson, the author of 1501 Ways to Reward Employees. From his work, you'll learn that money isn't always needed for all your retention efforts. Dr. Nelson reminds us that “you get what you reward.”5 Whether it's a personal note of thanks or simply letting staff know you appreciate their knowledge, skills, and commitment to patient care, recognition goes a long way in impacting retention efforts.

Back to Top | Article Outline

Putting R&R into practice

Take a moment to think about what makes you feel important in your role as a manager. That letter or e-mail from another department manager praising staff for exceptional work makes you feel so proud. Observing a technician transition to a novice new grad and then transform to an experienced clinical nurse reconfirms your position on hiring new graduates. Many of these sentiments are similar for staff. Transfer these positive feelings to how staff members feel when:

  • they know their manager recognizes the challenges they face in their job
  • they're praised and recognized by their manager
  • they know their manager will listen to their concerns
  • peers are made aware of how each person contributes to the team
  • they're encouraged to contribute their ideas and feedback
  • it's common knowledge that the manager promptly deals with conflict
  • challenging opportunities are made available as an award for progress.

Creating a work environment that engages staff members and makes them feel integral to the organization takes time. You may find you're already forming a work culture that's based on encouraging and motivating staff. Don't underestimate the value of these efforts in both the short and long term.

When you return to Table 1 at the beginning of this article, consider it as a set of directions that leads to effective recruitment and retention. Recruitment and retention efforts, planning, and strategies aren't a monthly, quarterly, or annual affair, they're a daily process. Each and every day you have the privilege in your role as a manager to lead, not because you have to but because you want to. This positions you at both the point of entry and point of potential exit for each employee that reports to you. Get in the proactive mode, hire the best, and then retain them!

Back to Top | Article Outline


1. Gostick A, Elton C.All In: How the Best Managers Create a Culture of Belief and Drive Big Resultss. New York, NY: Free Press; 2012:206–207.
2. Dunham-Taylor J, Pinczuk J.Health Care Financial Management For Nurse Managers. Boston, MA: Jones and Bartlett Publishers; 2006:809.
3. Twibell R, St., Pierre J, Johnson D, et al.Tripping over the welcome mat: why nurses don't stay and what the evidence says we can do about it. American Nurse Today. 2012;7(6).
5. Nelson B.1501 Ways to Reward Employees. New York, NY: Workman Publishing Company; 2012:13.
© 2013 by Lippincott Williams & Wilkins, Inc.