Healthcare organizations struggle to fill RN vacancies with experienced candidates. Projections from the US Bureau of Labor Statistics estimate that US healthcare organizations will have to fill nearly 200,000 open nursing positions every year until 2030.1 Faced with these workforce shortages, many organizations are implementing RN training programs for newly graduated nurses to create a pipeline to fill the need. Additionally, with the high volume of hiring for open RN positions and new training programs, nurse leaders can no longer manage the time-consuming, traditional hiring process of interviewing candidates one by one.
A group interview approach offers a practical alternative: it saves time, enables a group of multidisciplinary leaders to participate in candidate selection, deepens and broadens the interview, and improves the outcome. Although the group interview process is widely used in other industry sectors, it's not often used in nursing. This article describes the group interview process implemented in two hospitals in southern California. The CNO and nursing directors at a Level II trauma center and safety net hospital in South Los Angeles first developed this approach in 2018 as a pilot program. This process became the hiring interview standard. Subsequently, this interview process was instituted at a small community hospital in Riverside by the CNO, who was one of the South Los Angeles Hospital directors.
By conducting group interviews, the hospitals shortened the interview process by 70%: from 1 hour per candidate to 3 hours for 10 candidates. As a result, more key leaders could participate in the interview process. In addition, through the group interview process, leaders could better determine a good organizational fit, thereby improving retention rates.
Developing the pilot process
Interviews are central to the hiring and selection process and thus play an important role in whether organizations select suitable candidates to realize optimum performance and productivity.2 In 2018, as pressure mounted to fill positions, too few nurse leaders were available to participate in 1:1 interviews; thus, the nursing leadership team chose to implement a group approach with structured interviews. Many studies have investigated the efficacy of structured versus unstructured interviews to determine the best interview outcomes.3,4 Structured interviews allow all candidates to respond to the same questions, whereas unstructured interviews don't follow a fixed format and rely more on spontaneity. Levashina and colleagues found that job-specific, structured interviews were more valid forecasters of future performance than unstructured interviews.5
The team considered whether to ask situational or behavioral interview questions in the group setting. Situational questions present a hypothetical situation and ask the candidate how they would handle it. In contrast, behavioral questions ask the candidate to recall an experience and describe how they handled it. The premise of behavioral questions is that past actions indicate future behaviors, a presumption well supported by evidence.6-8 In contrast, situational questions allow the candidate to provide the answer they think the interviewer wants to hear and are less reliable indicators of future performance. Nurse leaders and the Human Resources (HR) department chose five behavioral questions: two on compassionate service, two on respect, and one on inventiveness (see Table 1).
Scenario-based questions were added to the interviews to allow candidates to interact and evaluate and analyze scenarios as a team (see Table 1). Scenario-based questions are intended to elicit critical thinking and reasoning and demonstrate how candidates prioritize care and collaborate with peers or on teams for the best patient outcomes. Scenario-based questions require candidates to review and synthesize information and communicate a plan.9 Having the interviewees participate in scenario-based questions as a group enabled the interview panel to analyze their interaction with each other, and evaluate who displayed leadership characteristics, who collaborated well, and who was silent in the background. This information was helpful in assessing organizational fit, a quality that couldn't be readily determined by interviewing one candidate at a time.
The interviewers scored the behavioral and scenario questions on a 5-point Likert-type scale and tallied them by hand at the end of each interview to provide quantifiable results for each candidate. At the end of the interviews, the interview panel discussed the top scorers for any marked variance in the scores and "red flags," such as candidates who complain about patients, don't take responsibility for their own actions, or are overly defensive in response to criticism (see Table 1). Each interviewer completed their scoring before any group discussion to preclude confirmation bias. Qualitative observations were documented during the interviews and shared during the postinterview discussion process. Upon completion of the discussion process, the panel identified top scorers so HR could offer positions to those candidates. The multidisciplinary panel selected approximately 20% more candidates than open positions to accommodate for those candidates who declined position offers.
The interview panel
With the ability to interview multiple candidates in one interview session, it became feasible to incorporate interviewers from different disciplines. The interview panel consisted of five panelists, including representatives from HR and Clinical Education, the CNO, and two nurse leaders at levels from assistant nurse managers to director. These interviewers brought different perspectives on candidates' strengths, weaknesses, organizational fit, and other characteristics demonstrated in the panel interviews. A multidisciplinary interview team lessened the potential for inherent personal biases to influence candidate evaluation. Implicit bias in the interview process can result in hiring candidates who subsequently perform poorly and bypassing those who may have been a good organizational fit.10
The process
This pilot was initiated at a Level II trauma center in South Los Angeles and a small, independent community hospital in Riverside. Both organizations were struggling to find qualified candidates to fill open RN positions. Based on the inadequate experience of the RN applicant pool, the leadership teams determined the need to implement a training program for new graduate nurses. Upon posting, 1,000 applicants applied for 30 positions. HR conducted the initial candidate screening for each person's level of education, RN license, and letters of recommendation. Based on applicant availability, candidates were then scheduled, in groups of five, into 90-minute time slots. The selection of five candidates wasn't scientifically based; however, it created equality with the number of multidisciplinary panelists. Candidates were informed prior to the interview that they'd be participating in a group interview process. Using this process, the interview panels could interview 40 candidates in 12 hours instead of the 40 hours needed for one-to-one interviews.
When the candidates arrived and were seated in the room, the CNO introduced the members of the multidisciplinary interview panel and explained the group interview process. This method provided instruction consistency with the different groups and emphasized the importance of the interviews from the CNO lens. The organization's vision for nursing was presented to the candidates. A series of behavioral questions in a round-robin format followed. Candidates responded to questions such as, "Tell me about a time when you were faced with a situation where there was no clear policy or procedure to follow. What did you do? What were the results?" and "Can you give an example of a time when you received negative feedback about your job performance? What was your reaction? What did you do?" (See Table 1.)
After the behavioral questions, the interviewees were given a hypothetical clinical scenario based on deidentified aggregate experiences with five patients to work on as a team. The condition of the five patients in the scenario varied according to the service area the candidates were interviewing for, such as childbirth, epigastric pain, pediatric fracture, burns, and a variety of medical or surgical conditions. The interviewees were then asked five questions, one at a time, with 2 minutes to work together on a response. The group was instructed to choose a different spokesperson for their answer to each question. While the candidates were working together, the interviewers observed the quality and levels of interaction and collaboration and evaluated their critical thinking and clinical reasoning skills. Evidence of patient-centeredness, compassion for peers, leadership, and leveraging of individual strengths were qualitatively evaluated to determine organizational fit and resilience. An overview schematic of the process is shown in Figure 1.
Outcomes
Researchers surveying new graduate nurse job turnover and intent to leave found that 55% had plans to leave, were thinking about leaving, or had already left their first job within their first year of hire.11 Both hospitals in our study were struggling with the turnover of experienced nurses and couldn't afford the turnover rates evident in the literature. Beyond making the interview process more efficient and effective, the aim of implementing the multidisciplinary interview panel and behavioral interviewing process was to improve retention.
At 1 year from hire, the retention rate for the new graduates was 86% at the Los Angeles facility and 93% at the Riverside facility, a 16% increase from the previous year for the Los Angeles hospital and a 19% increase for the Riverside hospital. Subsequent cohorts of new graduates have consistently maintained a retention rate of over 90% 1 year from hire.
In addition, the multidisciplinary team improved their interviewing techniques by learning from each other. For example, the HR representative contributed insights on body language and nonverbal communication styles, while the CNO provided strategic insight and perspective on the organization's mission, values, and workforce culture. Overall, teamwork improved by working together on the pilot project.
Informal postinterview discussions with candidates and subsequent new hires indicated a preference for group interviews over traditional interview formats. Interviewees shared that they were more comfortable interviewing as a group and appreciated the peer support and collaboration they experienced.
Lessons learned
Initiating a change to a long-standing process comes with challenges and, in this case, some valuable lessons learned. One challenge at the outset was engaging the multidisciplinary team in the process. Team discussion and conveying the importance of their participation helped overcome this hurdle.
Looking at nursing school GPA in the initial screening was of marginal value, as GPA didn't reflect the clinical reasoning skills or organizational fit demonstrated in the group interviews. Nursing school GPA review was subsequently dropped as part of the HR screening. Because many candidates were interviewed quickly and in groups, taking candidate photos (with their permission) before the interview sessions helped the panel members recall the candidates when making hiring decisions.
The multidisciplinary interview team improved their interviewing techniques by leveraging each other's strengths, and their teamwork skills improved by working together on the pilot project. Incorporating interview techniques and practices from other industries demonstrated the transferability of best practices. The transferability and scalability of group interviews demonstrated in other disciplines suggest its applicability in other areas of the healthcare industry beyond nursing.
Addressing candidate anxiety or communication skill insecurity is one potential limitation of this pilot. To mitigate this potential, all candidates and interviewers participated in a centering, group breathing exercise prior to the initiation of the interview questions.
Retention, retention, retention
Juggling time is always a challenge for nurse leaders. Many organizations are implementing new graduate RN training programs with the current nurse workforce shortage. When hiring newly graduated RNs, finding a good organizational fit is important for retention. In our study, implementing a group interview process with behavioral and scenario-based questions coupled with a multidisciplinary interview panel produced consistent retention rates of over 90% after the first year of hire. Future studies investigating longer-term retention would add to the body of knowledge on the efficacy of group hiring interviews.
INSTRUCTIONS Using group interviews to innovate the selection process for new graduate nurses
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