September 23, 2019

Soup to nuts recruitment: Finding and onboarding OR nurses–Part 2

By: Cynthia Saver, MS, RN

Recruitment is a daunting part of any OR leader’s job because of the time it takes to identify and evaluate candidates, who must then complete an extensive orientation program once they are hired. Part 1 of this three-part series covered marketing and application strategies for achieving recruitment goals (OR Manager, September 2019, pp 21-23). Here we turn to how best to gather additional information through tactics such as interviews, job shadowing, and testing.


Interview for success

Three common approaches to interviewing are behavioral, competency-based, and situational, says SHRM (the Society for Human Resource Management) (sidebar at right).

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Behavioral interviewing. This is a way to assess a candidate’s experience, personal attributes, and job-related skills. “Conducting an effective behavioral interview simply means asking applicants to tell you a story, and then listening to their story and seeing what it tells you about them,” says Bruce Tulgan, founder and chief executive officer of RainmakerThinking, Inc, a research, training, and consulting firm in New Haven, Connecticut (, and best-selling author of It’s Okay to Be the Boss.

Competency-based interviewing. This provides a sense of an applicant’s job performance and attitude toward work. Typical questions, according to SHRM, might include: Tell me about a time when you had to encourage others to contribute ideas or opinions. How did you get everyone to contribute? What was the end result?

Situational approach. Candidates are given a hypothetical scenario and asked to explain how they would respond. For example, Rey De La Cruz, RN, CNOR, OR education specialist at Greenwich Hospital in Greenwich, Connecticut, suggests asking applicants what they would do if a nurse was not pulling his or her weight on the team.

Preston Miller, MAOM, SPHR, SHRM-SCP

An important part of interviewing is determining cultural fit. “You can always train for skills, but you can’t necessarily train somebody to have the right attitude, who’s positive, who works well with the physicians, and who’s resilient in times of stress, which we all know every OR nurse experiences,” says Preston Miller, MAOM, SPHR, SHRM-SCP, human resources director for Houston Methodist Hospital—Texas Medical Center.

Who should be involved in the interview? To gain a wide range of perspectives, Natasha Luster, MSN, RN, CNOR, nurse manager of surgical services for Premier Health—Miami Valley Hospital in Dayton, Ohio, takes a three-pronged approach that includes peers, the educator, and herself.

“I think peer interviews are very important,” says Casey Orth-Nebitt, BSN, RN, director of surgery at Buena Vista Regional Medical Center in Storm Lake, Iowa. “If you aren’t doing them, you need to.” She points out that those working side by side need to have a good relationship.

“Peer interview panels create ownership,” adds Jane McLeod, MS, RN, co-founder/principal for Capstone Leadership Solutions, Inc, in Sault Ste Marie, Michigan. If someone on the panel says a person should be hired, he or she will work harder to ensure the new employee is successful.

Rose Sherman, EdD, RN, NEA-BC, FAAN

Those participating in an interview should be told how to ask questions and what not to ask. They should receive a copy of the job description and understand expectations for the role.

Rose Sherman, EdD, RN, NEA-BC, FAAN, professor emeritus at Florida Atlantic University in Boca Raton, Florida, and author of The Nurse Leader Coach: Become the Boss No One Wants to Leave, notes that the peer interview doesn’t replace the interview with the manager the employee will be reporting to, although some new graduates have started work without having met their manager.

Many organizations are thinking beyond the traditional lineup of interviewers. At Houston Methodist, physicians are included in the recruitment process, even if they have only a brief hallway conversation with applicants. “Some of our physicians are incredibly engaged in nursing success, and they want to be part of that,” Miller says.


Job shadowing

Jane McLeod, MS, RN

Job shadowing provides an informal peer interview opportunity, allowing more staff to have contact with a candidate than is possible in a formal peer review. “You’re setting up secret shoppers in your work environment, whether it’s the OR, PACU [postanesthesia care unit], or sterile processing,” McLeod says. “Many organizations have day-long job shadowing,” she notes, although others choose shorter times such as 1 to 4 hours.

Afterward, the manager can ask staff if they feel the candidate is a good fit for the job. “Everyone can behave for a 45-minute interview, but not everybody can behave for an entire day,” McLeod adds. “Red flags will come out in a day of job shadowing that wouldn’t have come out in an interview.”

Bruce Tulgan

Job shadowing typically takes place after the initial interview, but Nikki Walke, MBA, BSN, administrative director for perioperative services and sterile processing at Indiana University Health (IU Health), says they have had success with a 1-hour job shadow experience after a candidate has been screened by HR but before the formal interview. “It helps prompt questions they might have,” she says, adding that the educator meets with the applicant before the shadowing experience.

Job shadowing also helps the candidates, and McLeod suggests presenting it as an opportunity to determine if the organization is the right fit for the person. It can be used for nurses and other positions such as jobs in the sterile processing department (SPD). Offering job shadowing to high school students is a way to build future staff.



“I recommend testing serious job applicants for two reasons: to further verify their seriousness and to get an understanding of their aptitude for any key skills a job requires,” Tulgan says. Employers who want to use an outside vendor for testing should first ask the company to provide evidence of how effective the test is for predicting employee success.

At Houston Methodist, Miller says they assess for cultural fit by having candidates complete a short exam that gauges factors such as resiliency, customer service, and loyalty as part of the application process. “It helps us in forming a complete picture of who this nurse is,” Miller says. The results can also help in developing interview questions.

Peter Cappelli, the George W. Taylor Professor of Management and director of the Center for Human Resources at the Wharton School of the University of Pennsylvania, Philadelphia, says testing should be skills based. Cappelli sounds a cautionary note about the current plethora of algorithms based on machine learning that claim to find and assess candidates, noting that this type of science is “in its infancy.”

Problems include insufficient data volume to ensure accurate algorithms and uncertainty about which criteria truly predict performance while meeting legal requirements. However, Cappelli believes there is a role for technology in the hiring process. “Technology can help standardize the process so that everyone is treated the same way, and it can assess every candidate in the same way, taking out biases that, for example, come from typical interviewing,” he says.


More to consider

Tools such as peer interviews, job shadowing, and testing are helpful, but managers should remember that interviewing is a two-way street. “Some organizations are so focused on performance-based interviewing questions and interview panels that the candidates don’t have an opportunity to ask questions,” says Sherman. “They end up leaving the interviews without much information about the organization or the culture.”

Nikki Walke, MBA, BSN

Sherman adds that future employees need to understand the expectations of the job and the organization. That’s particularly important with Millennials, who often are anxious and fear failure. “They tend to have catastrophic thinking when they’re getting feedback from their preceptor or manager, and they feel anxious and like they are failing,” she says.

Managers can reduce anxiety by letting candidates know during the interview that the organization’s learning culture includes coaching and constructive feedback. If an employee becomes anxious or defensive in response to feedback after starting the job, the manager can then say something like: “We talked about constructive feedback during the interview. It’s part of professional development.”

Setting expectations includes giving candidates a clear understanding of the job. Walke has found that many SPD candidates do not understand what an SPD technician does. Now, applicants watch a video about this role before the interview to see if it’s a role they think they would like. Providing information like this helps avoid wasting time with a candidate who comes onsite for job shadowing and decides the role isn’t a good fit.

Cappelli cautions that recruiting applicants shouldn’t be a numbers game. “You want a smaller and better qualified pool of applicants,” he says. To achieve that, he says managers need to know exactly what they are looking for so that those who are not a good fit will not apply. “That requires being brutally honest about the downsides of your job or place to work,” he says. “No place is perfect, so if there is something that is going to annoy some candidates and likely make them quit, let them know that up front.”

According to Daniel Pink, author of Drive, human needs can be distilled into three desires: mastery, autonomy, and purpose. Employees want stimulating work and opportunities to have control over their work, and to feel work is connected to a greater purpose. Conveying that those three things are available in an organization will go a long way toward enticing a potential new employee.


Next steps

Once a manager has collected all the information about a potential employee, it’s time for the next step: deciding on whether to make an offer. In Part 3, we’ll discuss how to make a hiring decision and how to successfully onboard a new employee. ✥

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


Cappelli P. Data science can’t fix hiring (yet). Harvard Bus Rev. 2019.


Cappelli P. Your approach to hiring is all wrong. Harvard Bus Rev. 2019.


Pink D. Drive: The Surprising Truth About What Motivates Us. New York: Riverhead Books. 2011.


Sherman R O. The Nurse Leader Coach: Become the Boss No One Wants to Leave. Rose O. Sherman. 2019.


SHRM. Interviewing candidates for employment.


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

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