August 23, 2019

Soup to nuts recruitment: Finding and onboarding OR nurses–Part 1

By: Cynthia Saver, MS, RN

Staffing remains an ongoing challenge for OR managers, according to the 2019 annual OR Manager Salary/Career Survey, with open positions and turnover creating headaches. Attracting and retaining top talent is a crucial part of any OR leader’s job. This three-part series explores successful recruitment strategies: marketing (Part 1), interviewing and collecting data about a candidate (Part 2), and making the hiring decision and onboarding (Part 3).


Market effectively

Jane McLeod, MS, RN

Sponsored Message

“As leaders, we can’t recruit the way we’ve always recruited,” says Jane McLeod, MS, RN, co-founder/principal for Capstone Leadership Solutions, Inc, in Sault Ste Marie, Michigan. “You can’t go to a job fair, stand there, and wait for people to come and talk to you.” Instead, leaders need to partner with human resources (HR) staff and use social media, make connections, and leverage the marketplace.


HR partnership

To be good partners, managers need to help HR staff understand what the job of an OR nurse entails. “When they’re recruiting for you, they need to know that a nurse is not a nurse is not a nurse,” McLeod says. “They have to know very specifically what you need for your team at that time.”

Natasha Luster, MSN, RN, CNOR, nurse manager of surgical services for Premier Health—Miami Valley Hospital in Dayton, Ohio, explains to HR staff what she is looking for, what screening should be done, and what are automatic disqualifiers for a candidate, such as unwillingness to take call and multiple jobs in a short period of time.

Preston Miller, MAOM, SPHR, SHRM-SCP, human resources director for Houston Methodist Hospital—Texas Medical Center, says that specificity is especially key for hospitals that perform a wide range of procedures, which require different skill sets. “It’s not just the number of hands that we need, but the types of hands,” he says. He also talks with leaders about general staffing concerns to help anticipate needs. For example, a new surgeon who adds volume or a high turnover rate that leaves positions vacant may trigger a new recruiting effort.

The bottom line is that OR leaders and HR staff should be in regular contact to anticipate needs and plan recruitment strategies.


Social media and websites

LinkedIn, Facebook, Twitter, Instagram, and other social media outlets are playing an increasing role in recruitment. A 2017 study in the Journal of Advanced Nursing found that nurses exposed to a hospital’s LinkedIn or Facebook page felt more attracted to working at the facility. And younger nurses are accustomed to seeking information and connections online.

But social media must be used strategically. “What’s most effective is to get people to follow you on social media as a great place to work,” McLeod says. “You want to convey that your work environment is amazing.” Examples of postings include videos of fun employee activities, awards the organization or employees have received for quality and excellence, posts about popular physicians or surgeons, and employee feedback such as satisfaction scores. Job postings can then be woven into that, with links to more information and an online application.

A valuable resource to learn more about social media and how it can help with recruiting is the Mayo Clinic Social Media Network ( The free basic membership allows access to discussions and blogs.

A user-friendly website also ranks high on the list of marketing tools. The design should be current, and the website should be easy to view on mobile devices. Managers can provide feedback about those elements and recommendations for how to highlight nursing on the home page. Nursing should also have its own page that includes mission, awards (such as Magnet® recognition), and information about nurse leaders and staff.

The most effective social media and websites integrate technology to attract potential employees and speed the application process. Miller says Houston Methodist offers a chatbot named “Mia” (a computer program that simulates conversation with humans). When an applicant clicks on a nurse position posted on the website, the chatbot asks questions such as: Is there anything I can help you with? Can I answer any questions for you about the position? Can you tell me a little about yourself?

By obtaining some basic information, the recruiter can connect with candidates more quickly and effectively earlier in the process. “Nobody has the attention span to go through multiple screens and assessments to apply,” Miller says. “We make sure we’re having text-based or chat types of conversations rather than long phone conversations.”

At Indiana University Health (IU Health) in Indianapolis, potential employees can apply via a mobile app. “Most people look for new jobs when it’s convenient, including when they’re in bed at night, so this makes it easy for them,” says Aaron Wilson, MSN, MBA, RN, CEN, NE-BC, clinical director for perioperative services and sterile processing.

Preston Miller, MAOM, SPHR, SHRM-SCP

Speed is key in today’s society. “As we implement new processes, or alter some of our current ones, we’re looking to make sure we really focus on speed, and the short attention span that our world is moving into, so that we get as much as we can from candidates in one moment,” Miller says.

Targeting increases recruitment effectiveness. Miller is working with a digital marketing firm to find ways to attract nurses nationwide by citing advantages such as no state income tax, an academic medical center setting, and a mild winter climate—advertising in the Northeast during winter, for example.

The organization also carefully identifies whom to target. “Because of who we are, our sweet spot is the mid-career nurse who has 5 to 15 years of experience and who wants to work in a highly technical, highly innovative setting,” Miller says. With more nurses commuting longer distances, Houston Methodist also may broaden the search geographically (sidebar below).

Denver Health also considers target groups. Its website includes a specific area with information about the new graduate nurse residency program and a list of units where new nurses are being hired (

“I also put my phone number and email so they can contact me with questions,” says Kathy Casey, RN-BC, professional development specialist and nurse residency program coordinator. Casey says the organization attracts many new graduates from out of state, so she can let them know about opportunities and provide suggestions for writing a resume.

“It takes time, but I’ve found that it’s helpful for our organization to be in touch with new nurses,” Casey says. New nurses are required to sign a 2-year agreement that includes participation in the 1-year graduate nurse residency program. If they leave before 2 years, they pay back a prorated amount related to the investment for the residency program. Casey says she tells new nurses that it takes a year to become comfortable and confident in the professional RN role, and that the organization wants them to stay another year after that.



“The relationship between students and nurses who mentor students is highly underrated,” McLeod says. She recommends leaders ask staff who they would like to work with, and talk to students about job opportunities. Students may start in a sterile processing or nursing assistant job before being mentored for other roles.

Lorman, a training company in Eau Claire, Wisconsin, suggests other ways to make connections:

• Use an employee referral program that provides an incentive. For example, those who refer qualified nurses could be entered into a drawing for a free tablet.

• Contact successful former employees who have left within the past 3 years. They may be dissatisfied and ready to move on.

• Market internally and externally. The perfect candidate may be working down the hall.

Ease of recruitment can vary by geographic area. One factor is the number of schools nearby. “We have a nursing school in town that does clinical rotations in the hospital, and other schools come here as well,” says Casey Orth-Nebitt, BSN, RN, director of surgery at Buena Vista Regional Medical Center in Storm Lake, Iowa. Although Orth-Nebitt rarely has the opportunity to hire nurses with OR experience, she is willing to take on those lacking that experience.

Nikki Walke, MBA, BSNN

She adds that being a rural facility is both positive and negative: “The good part is that nurses want to stay here; the bad part is that we don’t have a large pool to draw from.” Orth-Nebitt says recruiting surgical technologists (STs) is particularly difficult because the nearby program only has seven slots, with most students quickly recruited by organizations out of state. “Not a lot of people are going into the field,” she says.

Having fewer schools in the area increases the importance of managers connecting with students, but those connections can pay off in any size market. “You might lecture on conflict resolution at a local nursing school and take the opportunity to let students know about the great things that are happening in your organization,” says Wilson at IU Health.

Nikki Walke, MBA, BSN, administrative director for perioperative services and sterile processing at IU Health, points out that face-to-face recruiting events still have a place in recruiting, but require a new spin. “We have open houses in coffee shops or restaurants to attract candidates instead of having them come to us [at the hospital],” she says. Informal environments like restaurants allow nurses to sample food and visit with leaders from different practice settings as they circulate among tables. HR markets the events through social media.


Consider creative options

Student programs, residencies, and other creative programs can help in recruiting OR staff.

Student interns are paid less than an RN wage, but the experience can build interest in the OR and can shorten orientation time. At Premier Health—Miami Valley, Luster partners with a local college to hire senior-year ST students to work 2 days a week and reimburses tuition after graduation when they work full time. “The costs are offset by having STs up and running in less time,” she says.

Sarah Bosserman, MSN, RN, CNOR, perioperative clinical nurse educator and CNOR coach and instructor at WellSpan Health—York Hospital in York, Pennsylvania, runs a 3-week perioperative nursing course in conjunction with the local school. Participants work in the OR as part of the course. Of the 55 who have completed the course since 2011, four were recruited for the OR at WellSpan Health—York Hospital. More than a dozen students have pursued perioperative careers at other facilities across the country.

Studies have shown that residency programs are effective in retaining new graduate nurses. The residency program at Houston Methodist accepts new grads as well as those who lack OR experience. Nurses with experience in critical care or a procedural area are particularly valued.

Greenwich Hospital in Greenwich, Connecticut, offers a nurse residency program to new grads and nurses without OR experience, whether they work within the hospital or at another facility. Rey De La Cruz, RN, CNOR, OR education specialist, says that before nurses are accepted into the program, they interview with HR, nursing leadership, and peers.

“They also spend a day job shadowing, so they know what they are getting into,” De La Cruz says. During the 12-month program, lectures are supplemented with clinical rotations in a variety of specialties. The first group, which completed the program in 2018, included six nurses, four of whom were hired for the OR and went on to earn CNOR certification.

Managers should provide flexible scheduling to attract Millennials, who now comprise about 44% of the workforce. At IU Health, Walke offers a variety of shifts, including 8, 9, 10, and 12 hours. “We’ve found that flexibility allows us to cover the needs in a different way, but also attracts recruits who see that there’s flexibility instead of a traditional 12-hour shift,” she says.

A thornier problem is call. Some of Walke’s staff work the night shift to mitigate the number of on-call hours required, although she says it’s a work in progress. “We really work with the staff to try to build models that reduce the call burden,” she says.


Continuing the recruitment journey

Once marketing successfully brings in candidates, the next step is to evaluate them. A major strategy for doing that (but not the only one) is the interview, which is discussed in Part 2 in this series. ✥

–Cynthia Saver, MS, RN, is president of CLS Development, Inc, Columbia, Maryland, which provides editorial services to healthcare publications.



Carpenter M, Van Hoye G, Stockman S, et al. Recruiting nurses through social media: Effects on employer brand and attractiveness. J Adv Nurs. 2017;73(11):2696-2708.


Cline D, La Frentz K, Fellman B, et al. Longitudinal outcomes of an institutionally developed nurse residency program. J Nurs Adm. 2017;47(7-8):384-390.


Lee J. Nurses resort to extreme commutes for better pay. LinkedIn. 2019.


Lojas G, Oneal G. Characteristics of commuting and non-commutingnurses in eastern Washington. J Nurs Edu Pract. 2016;6(4):1-8.


Lorman. 20 important tips for recruiting nurses. 2017.


Popov I, Salviati C. Traffic, trains, or teleconference? The changing American commute. Apartment List. 2019.


Tulgan B. The great generational shift. Update 2019. Rainmaker Thinking, Inc.

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