Recruitment rethink: getting the right nurse in the right role
Leading NHS trusts are recruiting ward sisters using an interview technique that focuses on the innate strengths needed to succeed in the role rather than competencies. The approach recognises that even a great nurse will struggle in the wrong job.
Leading NHS trusts are recruiting ward sisters using an interview technique that focuses on innate strengths rather than competencies. The approach recognises that even a great nurse will struggle in the wrong job
Senior nurses say it is clear when a ward is well run by a good sister or charge nurse. But it is also obvious that some ward sisters underperform in units where standards are not what they should be. Recruitment to this role, which is so vital for patient safety and experience, is not always a success.
To address this issue, a number of leading NHS trusts have begun using a new way of interviewing potential ward sisters, based on their strengths rather than their competencies.
The method, developed by Sally Bibb, founding director of strengths-based recruitment consultancy Engaging Minds, is designed to find the candidate best suited to a particular role. It is based on profiles of the attributes that make someone shine in a particular job; Ms Bibb has profiled a wide range of different roles, including barista, call centre employee and prison officer.
She says companies and trusts that have used the approach have seen improved performance, better employee engagement, less need for training to overcome weaknesses and a positive shift in culture.
In 2012 Ms Bibb was commissioned by senior nurses at the Shelford Group, which represents 10 leading NHS academic healthcare organisations, to look at ward sister recruitment. The group, which includes Imperial College Healthcare NHS Trust in London and Sheffield Teaching Hospitals NHS foundation Trust (see box), employs over 100,000 people. The senior nurses told Ms Bibb that good ward sisters lead to better clinical outcomes but pinning down who would make a good ward sister was difficult.
She studied 12 ward sisters identified by their employers as excellent at their job. ‘We find out what makes people who are great at what they do great,’ Ms Bibb says. ‘We are looking at what they have in common. When you profile these people you are looking to find out what their values and strengths are and what motivates and energises them.’
‘With the ward sisters, all of the directors of nursing said they would be naturally assertive. We discovered none of them were, but we saw plenty of assertive behaviour’
The profiling process involved a day of direct observation and a structured interview with the ward sisters, followed by conversations with people who knew them well. This produced a list of strengths that all good ward sisters appeared to share, including that it is important to them to make a difference, they love to be in charge and they get a buzz out of developing others.
‘On the surface, some of the ward sisters looked very different. Some of them were extroverts and some quite introverted, but they all shared these strengths,’ Ms Bibb says. ‘We nearly always find that there is something counterintuitive to what is expected. With the ward sisters, all of the directors of nursing said they would be naturally assertive. We discovered none of them were, but we saw plenty of assertive behaviour.
‘One day I was standing by a nursing station and a consultant came breezing in wearing a watch, which was not allowed. The ward sister stood up to him and I observed that it was costing her a lot, she was not finding it easy, and he was quite bolshie. In the end he took it off. It wasn’t natural assertion, it was that they have really high standards so they won’t allow any risk to their patients because they care about doing the right thing.’
The right fit
Trust staff involved in recruitment were then trained in how to carry out a strengths-based interview, using the list of strengths revealed in the profiling exercise. There is also a technical competency assessment to check if someone has the necessary skills and experience for the role.
‘The nice thing about strengths-based interviewing is that if the job doesn’t fit them, it becomes really clear to them in the interview and they leave thinking “I wouldn’t have been happy in that job”. With a competency-based interview people are left feeling deficient.’
‘Sometimes we found with our senior nurses that we had a square peg in a round hole and people were struggling’
The system acknowledges that people can be great nurses but may not be suited to the ward sister role. Imperial College Healthcare NHS Trust in London decided to re-interview all its ward sisters during a restructure using the new technique. A number did not fit the profile and were more suited to jobs such as consultant nurse, generally because they didn’t love being in charge, Ms Bibb says.
Janice Sigsworth, director of nursing at Imperial, likes the way the approach looks at a nurse’s ‘innate strengths’.
‘Sometimes we found with our senior nurses that we had a square peg in a round hole and people were struggling,’ she says. ‘They had done all the courses but they didn’t have the particular strengths. That was evidenced when I spoke to a senior nurse who was struggling and she said to me "I hate managing staff". About 80% of her job was managing staff. She was in the wrong job, but she had a lot of other strengths.’
After using the approach for ward sisters for about five years, the trust has recruited a strong team. ‘I know they will go the extra mile for the patient, challenge the rules and speak up for the patient, and this has had quite an impact on our organisation and nursing workforce,’ Professor Sigsworth says. ‘We have a shared approach through these common strengths.’
The ward nurse and healthcare assistant (HCA) roles have since been profiled, and there are plans to extend the process to hospital receptionists, who are generally a patient’s first point of contact with a service. Excellent nurses and HCAs were shown to have the same list of strengths, including being caring and reliable and believing it is important to do the right thing.
One drawback of the strengths-based approach is that it can take longer to conduct interviews. Given the number of staff nurses and HCAs at a large trust, this can be problematic, Professor Sigsworth says.
‘It is generally better not to recruit someone rather than take the wrong person,’ she says. ‘Rather than force the approach on my colleagues we need to move forward incrementally to make sure as much recruitment as possible can be done in this way.’
All the profiles are available free of charge for NHS trusts that have received training in strengths-based interview techniques.
Dame Jill Macleod Clark, professor of nursing at the University of Southampton, says the evidence so far suggests that the approach can improve the chances of finding the right fit for a particular role. She also sees its potential for reducing dropout rates among nursing students.
‘It would be interesting to see whether this approach could be applied successfully to the initial recruitment of students onto programmes and courses,’ Dame Jill says.
‘We find out what makes people tick’
Strengths-based recruitment has been used for all ward sisters and charge nurses at Sheffield Teaching Hospitals NHS Foundation Trust for several years.
‘The impact is that we make really good appointments and get the right people in the right job,’ says chief nurse Hilary Chapman. ‘It does what it says on the tin by testing the values and strengths of the people being interviewed much more rigorously than a normal competency-based interview does. We still assess competency for the role as well, but find out much more about the person and what makes them tick.’
She says the change is well embedded into the sister recruitment process. ‘It does take longer and it is a skill, so the people who carry out the interview need to be trained in the process,’ Professor Chapman says.
It is being incorporated into support worker roles but adapted due to the volume of people recruited. ‘We have spoken to Ms Bibb about the profile and the approach and built it into the assessment still using the same principles of strength-based recruitment,’ she says.
Erin Dean is a freelance health writer