They Both Begin With The Letter “R”

There is no doubt that everything within a healthcare delivery system is interrelated. You can’t have life saving brain surgery without someone taking out the trash. Some functions are just more related than others. For me one of the biggest misconceptions is that recruitment and retention are somehow very related.

Christi Green, who carries the dubious title of Manager of Recruitment and Retention for Wentworth-Douglas Hospital in New Hampshire, wrote asking how she could put more functionality into the “Recruitment and Retention Committee”. First, I think Christi should ask for a more realistic job title—either Manager of Recruitment or Manager of Retention—because the only thing recruitment and retention have in common is the fact they both begin with the letter R. That goes double for a committee.

Christi’s title would be very similar to Manager of Surgery and Rehabilitation without the alliteration. Things might begin in surgery but once that is completed, the patient moves on to rehabilitation just like once a hire is made, the candidate who is now a new employee moves on to the work site. What happens at the work site is why an employee turns over or stays engaged and productive.

Of course if a mistake is made in surgery, it is surgery’s fault and things should be corrected, but if they are not effective in rehab, it’s not surgery’s fault. In other words, when an employee turns over, it is not necessarily recruitment’s fault—more times than not it is the result of a poor practice environment or a manager who has not been trained to lead. The Human Resources Department often times takes responsibility for things over which they have no real control—like retention.

The problem for Christi and others in Human Resources is the fact that if retention is out of control, recruitment is a never ending merry-go-round. Make ten hires and get 12 requisitions. It’s hard to stay upbeat and focused when your professional life is dictated by the hiring managers who think getting a new experienced ICU RN is like putting in an order for a cheeseburger. Do you want that medium or well-done? Dressed or plain? Ask any HR professional and they’ll tell you there are no more burgers to be sent up.

So, for Christi to get control she might as well admit that she is in charge of surgery and rehabilitation and if she is going to control her professional world she needs to take control. Here are my suggestions:

1) Make sure recruitment is doing a good job. Since HR has been an easy target of blame for so long, if you are going to start questioning others, it is vital you have your own house in order. Make sure applications are being timely processed, communication is well executed and screening is top notch.

2) Document everything with numbers. HR cannot gain respect unless they speak the language of business and that is bottom line numbers. Emoting about how many open jobs you have won’t cut it, but showing how reducing the RN population by only 10 will drive approximately $500,000 to the bottom line will gain credibility and attention.

3) Take the numbers to the source of the problem. If you have a manager who is turning over CNAs at 79% but the system average is 32% turnover, then the answer is not for the recruitment team to find more CNAs for slaughter, but rather provide the tools for the manager to take responsibility and accountability. And, if you have managers who turnover is 5% for CNAs, reward their ability to provide a safe environment for employees.

4) Use numbers to make sure you are appropriately funded and staffed. You cannot expect recruiters to handle more than 35 professional positions or 60 entry-level positions. Recruiter staffing should be 1.2 FTEs for every 1,000 employees along with a .6 FTE of administrative help. Because HR has been a “cost center” functioning without supporting financial ramifications, positions have been cut for lack of demonstrated need. Remember when using these numbers, we are talking about recruiting (not employee relations or serving on the United Way campaign) and the system should not be in crisis, which is a vacancy over 8%.

Once the recruitment function is cutting edge, then take on retention. Candidates go through five steps when deciding to accept a position. Do the steps correctly and you’ll build a platform for retention. If you don’t, then some of your new hires won’t even show up for orientation. The steps to remember are:

1) Initial attraction;
2) Presenting to Human Resources;
3) Manager interview;
4) Compensation negotiations; and
5) Drug screen and post hire physical.

Building the platform for retention through good recruitment is simply making everyone feel special/wanted and that includes really listening and communicating, not treating them like they are disposable.

When developing retention programs remember the number one reason people leave is because of the immediate supervisor and the number two reason professionals (RNs, pharmacists) walk is because they don’t feel supported by enough entry level staff. Entry-level is important for everyone in the organization and yet they often time receive the least amount of respect.

So, my advice to Christi—beyond a new title—is accepting the fact you are the manager of two completely different functions. But, it is also incumbent for you to make sure everyone knows the facts—numbers, who is really responsible/accountable, and how much money can be pushed to the bottom line— and then just take control.

If you have a question you’d like me to answer on this blog please email me at I will continue to answer questions every few weeks and look forward to hearing your challenges.

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Thomas Delorme
Written by Thomas Delorme

VP, Digital Products & Strategy

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