The recruitment game: tips for employers. (Business Strategies).

It is not unusual for those of us who have worked at the corporate level of the healthcare industry to receive occasional calls from recruiters or the healthcare firms themselves. In my case, they would come monthly on a pretty regular basis until a couple of years ago. The calls decreased after change in Medicare reimbursement regulations in the late '90s, which was followed by a wave of healthcare corporate reorganizations, ultimately resulting in a reduction or consolidation of healthcare firms. And so it remained until recently, when the pace of recruitment calls seemed to pick up. As the calls increased, so did my curiosity. I decided to contact a colleague, a professional recruiter for the healthcare industry, to see if she could shed some light on the situation.

Nancy West is a senior executive search consultant with Provider Management, LLC, headquartered in Portland, Oregon. Provider Management is a national recruitment firm with offices located throughout the United States. The firm was founded in 1997 by its president, Stan Smith, who also happens to be a licensed nursing home administrator.

With a wealth of experience and a keen understanding of the long-term care industry, West was able to offer information that could be helpful for your future recruitment strategies, both from an employer and a job-hunting perspective. We will address the employer perspective m this installment, and offer West's tips for a job hunt in a subsequent issue of Nursing Homes/Long Term Care Management.

Hyatt: Lately the number of calls from recruiters has increased. What do you think this is related to?

West: There are several factors. There definitely seems to be a shortage of professionals with industry-specific experience, particularly in postacute care. Many people in leadership or management positions have left the industry because of the intense scrutiny and pressure it is under. Also, the industry has seen so much financial instability and turmoil in the last few years that many people who feel they are in a stable position are less likely to want to make a change. Before the Medicare Prospective Payment System (PPS) came into play, there was more opportunity to develop new programs. Prior to the PPS regulations, a person would be more willing to leave a position, even if he/she were happy in it, for the possibility of growth. Today, that same person would be more cautious.

Hyatt: What do you see as the trends in the industry in terms of administrator and nursing administrator supply?

West: We are being told by our candidates and clients, and by some state licensure boards, that fewer new nursing home administrators are entering the field. Part of this results from companies cutting back or even eliminating administrator-in-training (AIT) programs. Another factor is that existing administrators are leaving the field before retirement age. What I find alarming is that many of the administrators who have spoken to me about this are people who have been operating facilities for a long time and who have track records of providing quality care and keeping their facilities financially sound. The reasons they cite for leaving include more stringent and punitive rules and regulations; the survey process becoming more difficult; more lawsuits, many of them frivolous; and corporate cost cutting that makes it difficult to run a quality facility. Interestingly, very few of them have said that dissatisfaction with their own personal income is the reason.

Regarding the nursing shortage, last year I sat on a task force that reviewed a July 2001 report by the United States General Accounting Office (GAO). This report, titled Nursing Workforce: Emerging Nurse Shortages Due to Muliple Factors (GAO-01-944), while not able to draw absolute conclusions, did cite trends. It suggested that there is an emerging shortage of nurses available or willing to fill some vacant positions in hospitals, nursing homes and home care. It added that the current registered nurse (RN) population is aging, while fewer young people are entering the RN workforce. The study cited dissatisfaction with working conditions, such as inadequate staffing, increased overtime, heavy workloads, a lack of sufficient support staff and poor wages, as reasons. Those findings are very similar to the things we hear from the candidates themselves.

Hyatt: What are some of the ways in which employers might recruit long-term care talent?

West: At the corporate or facility level, if you are seeking a confidential replacement of a current employee, you should use a recruiter that you know and trust who can make discreet inquiries without revealing that it is your company until a qualified candidate is identified. If there are other executives or facility managers in your company who know about the replacement, ask them whom they would recommend. If it is not a confidential situation, a good way to reach a large number of people is to advertise in national industry publications. Be as specific as you can about what you require in terms of industry experience, licensures or education, because that will cut down on the number of resumes from unqualified people.

If the facility is in an area where there is a very limited talent pool, such as a rural area, use a recruiting firm that works nationally and could find candidates who are willing to move to the area. You can also network with the industry's professional associations that have the most contact with their corporate members. Job fairs can be effective mostly at the facility level, but be sure someone who has a very positive attitude about the work environment represents the facility.

Hyatt: When a prospective candidate comes for an interview, who should participate in the interview?

West: If possible, the candidate should be provided, with an itinerary and interviewing schedule listing the names and titles of the people he/she will meet. If a candidate is arriving by plane, someone from. the company should meet the individual at the airport and bring him or her to the office or facility. If that is not possible, you should provide a rental car, a map and clear directions to the office.

Give a tour and introduce the candidate to the staff, as well as to key executives or managers. Ask the candidate for observations, and ask what he or she would change or improve. The key is to get the candidate to relax so that when it is time to ask questions, the conversation will flow more smoothly.

Talk to the individual about the organization and its history, its mission and the culture that exists or is being developed. This is important, because candidates are not only selling themselves to you, but you are also selling yourself and your organization to them. A review of the parameters of the position and your expectations can be used to frame the interview. Ask questions not only about his/her background, education and work history, but also about what he/she likes to do in spare time. This will give you a more complete picture of the whole person and how the candidate balances his or her work and personal life.

Behavioral interviewing is also an excellent method. Ask the candidate about an actual situation and how he or she handled it. If you ask about a real situation the candidate had to handle, you will get a more honest answer than if you ask about a hypothetical one, where the candidate might be more inclined to give the answer he/she thinks you want to hear.

In a corporate interview, the person that the candidate will report to should have an individual interview with the candidate, but it is also important to include others at some point. If the potential candidate will be working on a team with other corporate personnel, those people should be included in the interview process to help determine if the candidate is a "good fit."

The same rules apply at the facility level. It is a good idea to have the candidate meet with department heads and other staff. Sitting down together with staff that the candidate will supervise is also a way to assess leadership and team skills.

Hyatt: What general signals should the employer look for?

West: A few good ones:

* Do they make eye contact?

* How do candidates carry themselves? Do they look confident? Do they look aloof, distant or arrogant?

* Do they engage in conversation as active listeners or do they interrupt?

* Do they answer your questions directly or do they go off on tangents?

* Do they think before they speak?

* Are they articulate?

Hyatt: How important are background checks--after all, don't most people only give references from folks who will be biased in their favor?

West: We are seeing more companies conducting criminal background checks on potential employees, even on those for whom these checks are not mandatory. References are important even if they are biased, because it is surprising what people will tell you, or what clues they will inadvertently drop, if you ask open-ended questions based on information you receive. Ask the candidate for references from supervisors and from people he/she has supervised. If a reference does give you some very negative information, try to verify that with one or two other references before making a decision. Another use of reference checking is to get a better idea of the kind of support or additional training the candidate might need.

If you are hiring a nursing home administrator, nurse administrator or other licensed personnel, you should check the status of his/her license with the state licensure board of each state where he/she holds, or has held, a license. Ask these boards if there are any outstanding actions against this person. If there are, ask the potential employee to explain them. Check this out independently.

West has offered something to think about for an employer seeking to recruit good management staff in today's tough market. I would like to thank her. She can be contacted at [e-mail].

In the next column, she will offer guidance for the administrator who is on his or her own job search.

Laura Hyatt, MBA, is president of Hyatt Associates, Los Angeles, California. To comment on this article, please send e-mail to [e-mail]