Thursday, July 21, 2016

6 Considerations When Hiring Nurses for Home Care

Suddenly, You Need a Nurse at Home
“Each year, millions of older people---those 65 and older---fall. In fact, one out of three older people falls each year….” [U.S. Centers for Disease Control and Prevention]
The consequences are sudden and serious. For example, the CDC notes that each year a quarter of a million older people in the U.S. are hospitalized for hip fractures, and more than 95% of these are caused by falling.
My own mother fractured her hip from a fall in 2010 at the age of 93 and was thereafter virtually bedridden, with continual nursing care at home, until her death five years later. We hired our own nurses to give private duty care for her and for my wife, quadriplegic and ventilator-dependent due to multiple sclerosis.
As employee hiring consultant Stan Dubin notes in his How to Hire the Right People, mistakes in hiring lead to lost wages, theft, loss of privacy, poor performance, and bad morale. In the home care setting, poor choices can also lead to patient injury and depression, along with family disruption.
First, How Do You Find Nurses?
We started by advertising in the Help Wanted part of the classified section of the local newspaper. We briefly described the situation to give some clue as to the challenge and the environment. We stated the hourly wage and noted that Social Security and Medicare would be deducted, this to eliminate those who want to work “off the books,” a sure-fire invitation to later troubles.
One could also advertise in other local publications and on the Internet. You can also ask people who have employed nurses before and ask your family doctors.
Second, Manage the Interviews
During the first week we ran the ad, we got so many calls that scheduling the interviews became a challenge, and we started asking and answering questions that would enable the caller and ourselves to get a quick idea of whether the caller was likely to be a good match, a pre-interview to save each side some trouble. For example, we required flu shots, to protect the patient, and some nurses would not agree to get them. Some sought to work “off the books.” No. That’s an invitation to trouble.
After this pre-screening, you should schedule some to come for an at-home interview. You will want to see if they can find your home, come on time, and behave suitably in the home setting. Have a third person (besides the candidate and yourself) present during the interview. 
Third, Make Salary and Conditions of Employment Clear
We offered the same wage for RNs and LPNs, although typically RNs get significantly more than LPNs. Our wage was high enough to attract local RN candidates and to attract LPNs from farther away. Other things being equal, we would give preference to the RNs, better-trained than the LPNs, although an experienced LPN was sometimes preferable to a new RN. 
Make the conditions of employment clear: wages, deductions, hours, scheduling, vacations, sick days, taboos…have a list and go through it with the candidate. If an issue arises after hiring, you will be glad you did.

Fourth, Clarify What You Need from a Candidate
Have them bring a resume and a copy of their nursing license, along with their driver’s license and Social Security card. Make copies for your records. The resume should be neat, virtually error-free. Gaps in employment need to be explained by the candidate. Explore their reasons for having changed jobs. Responsibilities should have increased over their career and should include the duties you will ask to be handled. 
We developed an interview form, to enter information about the experience and training of the candidate, and we asked each about allergies or morbid fear of dogs (we had a Golden Retriever), and we noted that there could be no smoking on the job (fire safety). We discussed why the candidate was available, for what dates, days, hours, how she viewed home care, what problems she foresaw in the situation, and we obtained her references and often a resume. We made sure their English language skills are adequate.
Fifth, Explore Attitudes as Well as Skills  
Dubin has suggested discussing of what it means to be “responsible:” coming on time, reliably; performing all required duties; going beyond the required duties occasionally; alerting management to problems; cooperating with co-workers; suggesting improvements to care; being loyal to the patient and the family; respecting their privacy in the home and outside. While getting paid is an important reason for working, it should not be the only reason; some element of desire to perform nurturing, personal nursing care should co-exist with it.
Sixth, Follow Up after the Interview
After the interview, we gave them a subjective (and not revealed to them) grade that reflected both objective elements as well as subjective elements, trying to assure both technical competence and interpersonal acceptability. Intelligence and positive attitude were prized, though education and experience counted too.
We found it important to check references. The best nurses were usually enthusiastically praised by former employers, but others were given lukewarm evaluations or our calls were not returned.
We called back all those we interviewed, informing them of our decision to hire or not to hire. Those not hired were just told we found someone who fit  our needs better.
This process resulted in a staff that received many compliments from the medical professionals with whom we interacted, a staff whose members averaged many years of service with us.

Do you know people who have hired nurses for home care? How did they select them?

A former Harvard science professor, Dr. Cooper continues to publish, and he helps others write and publish their books, via his  His life's predominant theme has been a half-century romance with Tina Su Cooper, his wife, now quadriplegic due to multiple sclerosis and receiving 24/7 nursing care at home, as discussed at their website here.


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