Survey Data Reveals Disconnect and Collaboration Between HR and Nursing
In healthcare, you’ll often hear the term “Journey to Excellence”, which could refer to the Malcolm Baldrige Quality Award framework, the quest for ANCC Magnet Recognition®, or it could be adopted as a hospital’s unique initiative to improve patient satisfaction and patient outcomes. I think that “Baldrige-level” excellence is hugely influenced by two critical departments–nursing and HR. Earlier this year, we launched the HR & Nursing Excellence Survey. The purpose of the survey was to better understand how best practices around talent and learning management (i.e., HR excellence) drives better nursing performance (i.e., nursing excellence).
The survey data from nearly 300 nursing, education, and HR participants revealed that there may be a communication gap between nursing and HR when it comes to prioritizing excellence initiatives. For example, there seems to be a disconnect between talent aquisition and nursing leaders around hiring best practices (such as hiring for culture fit). But there’s good news. When it comes to performance and learning initiatives, organizational development, education, and nursing teams seem to be on the same page.
When asked which excellence initiatives their organization is working towards, 80% of survey respondents indicated that increasing their Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey scores is a top priority. However, of the 80% who said HCAHPS is a major concern, only 25% of those were nurses versus 43% of HR respondents.
“Perhaps this data reveals that nursing leaders are looking beyond HCAHPS scores and focusing on the factors that are going to drive excellence in nursing,” noted Jim Kinsey, Director Planetree Member Experience, Planetree. Kinsey defines nursing excellence as “the intersection of skill and compassion.” This intersection creates a transformative culture that he believes can boost HCAHPS scores. “We need to help providers understand that in order to reach excellence, while we can look at scores, we also have to look at the cultural transformation necessary to maintain those high scores, and that should include nursing excellence.”
Dr. Frederick Morgeson, Eli Broad Professor of Management at Michigan State University and Scientific Advisor for HealthcareSource, recently published research suggesting that nursing excellence is one of the biggest drivers of higher overall HCAHPS scores. His research indicates that of the eight summary measures that the Center for Medicare and Medicaid collects, those focusing on nurse communication have the largest impact on survey scores. For example, hospitals with higher scores for nursing communication have higher overall quality ratings and there’s a greater likelihood patients will recommend those hospital to friends and family. In addition, healthcare organizations with ANCC Magnet Recognition® have higher overall HCAHPS scores. Morgeson recommends that, “Hospitals should focus their efforts on enhancing nursing excellence as a way to improve HCAHPS survey results. Improving nursing might represent one of the most effective ways to positively impact the patient experience and patient satisfaction, key elements of the HCAHPS survey.”
According to Kinsey, part of achieving nursing excellence is onboarding nurses who already embrace compassion, teamwork, and customer focus. When asked if they are assessing nursing candidates’ cultural values during the hiring process, 72% of survey respondents said yes, and they are using behavioral interviewing techniques. However, only 27% of respondents said they are using behavioral assessment software during selection. Reviewing the data by role revealed that 48% of talent acquisition professionals said they use this software, while only 25% of chief nursing officers (CNOs) and directors of nursing (DONs) indicated the same.
“This discrepancy could indicate a lack of communication between HR and nursing when it comes to hiring best practices. I think it’s very important for HR to meet regularly with hiring managers and directors in the nursing department,” said Teri Kuttenkuler, HR Director, VCU Health System. “At VCUHS, we stand before our nursing manager and director councils regularly to go over their questions and present our progress with hiring.”
When asked if respondents use job shadowing during the hiring process for nurses, 43% of the total respondents said, “No, and we don’t have any plans to.” However, HR was less likely to indicate that job shadowing is a priority; 46% of VPs of HR said it is something they have no plans to implement versus 39% of CNOs and DONs.
According to Brenda Reinert, Human Resource Director, Tomah Memorial Hospital, this data suggests that nursing leaders see the value of shadowing but HR may not be eager to own this program. “It could be due to policies that don’t allow it or it could just be the fact that they don’t realize the benefits of shadowing.”
HR may not see how it can help with nursing excellence if they don’t understand what benefits the nursing managers get out of this type of program. “Shadowing gives nursing candidates a feel for the pulse of a unit. It also offers nursing managers insight into how engaged the candidate is in patient care,” noted Kuttenkuler. Despite the hesitation from HR, the numbers for launching this type of program are growing─22% of survey respondents said they are working towards implementing a job shadowing program for nurses within the next year.
Although there may be a lack of collaboration between talent acquisition teams and nursing, the performance management and learning data revealed positive trends. 48% of respondents said their education team works with nursing to develop their performance appraisal process, and 44% of respondents said their education team works with managers to set service excellence goals for nursing during this process. In fact, 83% of nurse managers indicated they rely on education teams to help them set these goals for their staff.
This type of cross-collaboration on performance management processes between HR, education, and nursing can help managers identify the performance issues that influence nursing excellence. “Our CNO really wants to see that directors and managers are including all kinds of nurse sensitive indicators in the performance management process. We’re looking at things like, ‘How are nurses impacting blood stream infection rates or pressure ulcer rates?’ This data is then added to performance appraisals,” remarked Kuttenkuler.
By working together, education and HR can support nursing managers’ initiatives to improve nursing performance; for example, by offering education that can help decrease infections if the performance data supports this initiative. In addition, through setting goals and recording nurses’ progress, organizations can increase employee accountability. Kuttenkuler feels accountability is the key to nursing excellence. “When we hold them accountable, nurses are more interested in knowing how they can have a positive impact on patient satisfaction and outcomes.”
The survey data revealed that many organizations are using a variety of methods to offer nurses learning opportunities in order to achieve nursing excellence. 36% of respondents indicated that they offer nurses a “clinical career ladder” and have nurses create an activity record focused on professional goals. A vast majority, 70%, said they offer a blend of eLearning and in-person education opportunities for their nurses that go beyond the general compliance requirements. Senior nursing leaders in particular are focused on offering professional development opportunities for their nurses; 84% of CNOs and DONs said they offer professional development that goes beyond compliance.
At Tomah Memorial Hospital, they have a dedicated education coordinator who works closely with nursing leaders to offer their staff professional development opportunities. “Our education director sits with our nursing managers and directors to decide what education our nurses should receive and what formats make sense. Our nursing leaders are very involved to ensure nurses can advance and improve through education,” said Reinert. “We find value in offering nurses education that goes beyond compliance needs.”
While a majority of hospitals focus on achieving higher HCAHPS, HR, education, learning, performance, and nursing teams must all work together to achieve nursing excellence—one of the biggest drivers of overall hospital performance.
To learn how HealthcareSource clients are achieving nursing excellence through talent and learning management best practices, download our white paper, Journey to Magnet Excellence® How Talent Management Influences Nursing Distinction.