Avoid hiring the wrong clinicians: Ask in-depth interview questions, spot red flags
ED managers should examine hiring practices to ensure that the best nurses and physicians are selected
Hiring choices have an effect on any ED's overall efficiency, but selecting the right nurse or physician is a challenge. "Looking at somebody's file and deciding to interview that person is easy, but making the decision about who to hire is probably one of the most difficult things an ED manager does," says Dighton Packard, MD, FACEP, medical director of the ED at Baylor Medical Center in Dallas, TX.
ED managers should make an effort to uncover as much information as possible about the applicant during the interview, notes Packard. "Everyone's on their best behavior during an interview, and you don't really know a doctor unless you've worked with them for a few weeks," he says. "That's why it's important to dig as deeply as you can by asking questions that are more in-depth, and by talking to people who have worked with that person."
Regardless of the urgency of your department's needs, the selection process should be stringent, stresses Liz Jazwiec, RN, a Crestwood-IL-based consultant specializing in hiring issues. "No matter how short-staffed you are, it should never be easy to get a job in your ED," she notes.
Spot red flags
A significant period of time that is unaccounted for is a sign of a possible problem. "If there is an unexplained six-month lapse on a resume, you've got to ask for an explanation of where they were during that time," advises Packard. "It could be a sign that they're physically or emotionally unstable. After all, if they were on a sabbatical missionary in Kenya, that would probably be on their CV."
Another red flag is not staying in one position for a long period of time. "They may put a positive spin on it by saying they've had experience in a lot of different places, but it could also mean the person has trouble holding down a job," says Packard.
Bad-mouthing former colleagues is also a bad sign. "If you ask them to describe their current or former boss and they say anything negative, they should be ruled out," says Jazwiec. "They ought to be at least smart enough not to do that."
Some potential red flags, such as a past struggle with substance abuse, shouldn't necessarily rule out an applicant. "Impaired physicians are usually upfront about their problem. If somebody has had adequate treatment, I think everybody deserves a second chance," Packard says. "But if they have had two episodes, I am very frank and tell them, you don't want it on your record that you've been turned down, so you should probably apply at a department where you've got friends, or a place which has a greater need than our ED."
While some applicants coming from other specialties may not be appropriate for the ED, it's important to find out the reason for the switch. "Some nurses may have done critical care as a step in coming to ED, or may be leaving the unit because it's too structured. So the fact that they are switching fields shouldn't exclude the candidate automatically," says Maryfran Hughes, RN, MSN, CEN, nurse manager of the ED at Massachusetts General Hospital in Boston. "With those applicants, you need to do more work in screening the applicant to find out how flexible they are."
White lies on resumes may be problematic. "I worry a little about people who try to present themselves as having emergency experience who don't have it in any formal way," says Hughes. "Sometimes when you scrutinize their claim, you find out the reality is they've worked on the floor and had to float occasionally."
Sometimes, applicants for staff nurse positions will attempt to persuade you that they don't need nursing experience. "Some people who have had prior experience as X-ray techs, EMTs, or physical therapists will try and convince you they don't need to meet minimum requirements because they have had health care experience," says Hughes. "If they don't see that the nursing role is different, it makes me a little worried about where they are coming from."
Other red flags depend more on the interviewer's instincts than anything that appears on a resume. "For me, red flags include people who have a rigid way of thinking, people who talk at you instead of to you, and people who make me uncomfortable the more I think about my meeting with them," says Corey Slovis, MD, chair of the department of emergency medicine at Vanderbilt Medical Center in Nashville, TN.
Here are some tips to consider when screening applicants:
Always do face to face interviews. "The only tried and true way of knowing whether the individual is the right person for the job is to meet with them and talk for at least 10 to 15 minutes," says Slovis. "I think you learn a lot about a person by looking at them and their body language and facial expressions as you talk face to face. The `wrong' people are usually pretty obvious."
Involve the rest of the ED staff. "For physician faculty recruitment, I have at least two other people meet with the prospective faculty member. Then, we get together to discuss our impressions as a group, rather than doing a one-on-one debriefing," says Slovis. "I find the group can really come to a consensus and openly facilitate a shared vision of the candidate's potential fit."
Nurse managers should interview physicians as well. "Getting nursing perspective is important, because there has to be a sense that the physician will fit in with the team," says Nancy Auer, MD, FACEP, director of emergency services at Swedish Medical Center in Seattle. "Our nurse manager always asks physicians, `If I call your hospital's nurse manager, what's the best thing and worst thing she would tell me about you?' The answers she gets are pretty revealing."
Applicants should have multiple interviews, suggests Jazwiec. "Often, the staff will have a gut feeling for whether or not the person is going to be a good fit," she says. "That can take the form of an informal lunch meeting with three or four staff members. Then, when the person comes on board, it's an advantage for them because the staff has already given them a vote of confidence."
Trust your gut instinct. "Being in an emergency medical group is like a marriage, because you work together so closely," Auer notes. "In addition to having all the right credentials, you will need somebody that meets the social criteria for your ED. For that, you need to trust your instincts about that person."
Communicate the unique needs of your ED. "Every ED has its own character. As a director, you need to realize that fact, and put those characteristics in terms of words an applicant can understand," says Packard. "Once you can articulate the traits of your ED, you can explain how those traits translate into what you are looking for in a physician."
Ask questions designed to reveal style of practice. Develop thought-provoking questions that elicit revealing responses (see sidebar, above). "Asking a physician if they like to work at a busy or slow pace won't tell you much about the way they practice. Asking about how they would handle some of the most difficult problems you face in emergency medicine is much more telling," says Packard. 'm much more interested in social interaction skills than whether they know how to treat a particular illness."
If a physician is board certified, his or her clinical skills should be a given, says Packard. "If a doctor has been through an adequate training program, you need to assume their skills are sufficient. You won't learn much by asking a couple of clinical questions in an interview setting."
In fact, posing questions about clinical practice may offend qualified candidates. "One colleague put all applicants through a written and procedures test he had devised, with questions like `show me you can intubate that mannequin.' As a result of that, he lost an enormous amount of prospective residents," says Packard.
Don't interrupt. When you ask a question, give the applicant room to respond. "It doesn't do any good for you to do all the talking. The best thing to do is be quiet and just listen," recommends Packard. "After they answer your question, they may go on to expound on that, and tell you, `This is how I handled something similar.' If you let them talk, you will get into their philosophy of practice, and get an idea of their mores and ethics."
Give the applicant a chance to observe your ED. "If an applicant is on the fence and unsure if your ED is the right place for them, suggest that they spend some time just observing the environment, rather than take a risk and make the wrong decision," advises Hughes. "Give them a few hours to get a general sense of the environment, because all EDs have their own unique personality."
At Massachusetts General's ED, a staff nurse gives the applicant a personal tour of the ED. "I encourage the applicant to ask the staff nurse any questions, to validate what I told them about the schedule or anything else," says Hughes. "You want a win-win situation. Even if you want to hire a candidate, it won't work out in the long run if it's not a right fit for them."
Some applicants are more comfortable asking a staff nurse about the ED, notes Hughes. "Just as I want them to be honest with me, I want them to understand what they are getting into," she says.
When in doubt, don't hire. "If there is any doubt in your mind, it's better not to hire, because it's so hard to fire," says Jazwiec. "It's better to take the effort up front to be extremely selective. If everything else is positive, but you hear one thing that is negative, you have to go with your gut instinct."
Be discreet about your decision not to hire. It's not necessary to give a detailed explanation when you decide not to hire. "We did have one physician who was perfectly fine but personality-wise didn't fit with our group," says Auer. "Your explanation needs to be neutral. Just tell them it was nothing pertaining to your medical competence, we simply feel that personality wise, this is not the best fit, and you probably feel the same way."
Avoid explaining your decision. "If they ask you why you're not hiring them, just say, I don't think you're a fit for my place," says Packard. "You have no requirement to give out more information than that. I tell applicants that quite honestly, something that might be a no hire for my ED might not bother somebody else at all, and leave it at that. As long as I'm not discriminating against race, sex, or religion then I feel very comfortable doing that."
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