Holman, Brooke
Predicting New Graduate RN Success Through Pre-Hire Simulation
Faculty Mentor: Katreena Merrill, RN PhD, Assistant Professor College of Nursing
Introduction
Decisions about which new nursing graduate to hire can be difficult. Pre-employment testing and assessments have shown to aid in this process. Pre-employment testing, including both medical tests (drug screening) and psychosocial testing (simulations), are well known in both the health care field and other industries. Simulation is often used in healthcare for employees to teach and assess critical thinking. With the implementation of simulation in healthcare, however, little information is available related to how simulation can help us in the pre-employment process, especially when deciding which new nursing graduate to hire. The purpose of this paper is to discuss the process that was used to evaluate the effectiveness and satisfaction of pre-hire simulation at Dixie Regional Medical Center. This paper will also discuss the progress that has been made to publish the findings in a peer-reviewed nursing journal. It is hoped that this publication will help inform research associated with pre-employment simulation.
Methodology
A mixed method approach was used for this project. A review of the literature provided a foundation and background off of which Katreena Merrill and I could build. Studies were collected from several online databases, including CINAHL and PubMed (1996-2014). Keywords included “pre-employment, critical thinking, nurses, simulation, and new graduate”. Key inclusion factors used in this review included publication within the past ten years, articles specifically focused on simulation research used as a means of assessment rather than a means of teaching or learning, articles that assessed the benefits of pre-employment testing on future career success, and articles that discussed the relationship between simulations and either turnover rates, hiring expenditures, quality of staff, or staff and employee satisfaction. Articles excluded from this literature review had factors including a publication date greater than ten years ago, articles that based simulation research in a career field other than nursing, and articles that focused on simulation research as a means of refreshing, learning, or teaching new skills.
Primary research was included with the distribution of a questionnaire consisting of thirteen questions to the staff at Dixie Regional Medical Center (DRMC). The purpose of this survey was to evaluate the satisfaction levels of the staff members with regards to the pre-hire simulation and its effects it had on the unit and employees. The survey included seven demographic oriented questions accompanied by six questions specifically targeting the surveyor’s opinion of the pre-hire simulation. We received fifteen responses from full time employees all of whom, with the exception of one, had had personal interaction with the pre-hire simulation at DRMC. These responses were analyzed as both quantitative and qualitative data and were used to help determine staff satisfaction ratings of pre-hire simulation at DRMC.
Results
Research from the literature review suggested that use of pre-hire simulations helps decrease turnover rates and fiscal stress while helping to increase satisfaction of the manager, staff, and new graduates, and increased overall quality of staff in the workplace. Our research focused on the evaluation of staff satisfaction with pre-hire simulations. Our questionnaire responses consisted of 21.4% who had attended a pre-hire simulation, 42.9% who had oriented nurses who had experienced pre-hire simulation and who had hired nurses who experienced pre-hire simulation, and 50% who had participated in conducing pre-hire simulation. Overall 85% of the
staff at Dixie Regional Medical Center reported pre-hire simulation having a medium to large effect on their satisfaction of the new hire process. Eighty-five percent of the staff also reported feeling that the pre-hire simulation program had increased the safety of new graduate nurses and 58% of the staff reported the pre-hire simulation program having an impact on decreased turnover rates. Other comments made by staff members included, “I feel that the simulations gave new grads an opportunity to gain confidence,” “I believe it is a better way of screening candidates,” “Patients receive better care from nurses that have been selected in pre-hire simulation,” and “I felt more confident in the abilities of the new hires when I was training them because I knew they passed the pre-hire simulation.”
Currently, Katreena Merrill and I are compiling the results of our questionnaire and research to submit for future publication in a peer-reviewed nursing journal. We hope to start the process of moving the idea of pre-hire simulations to the forefront of nursing literature, promoting ideas for future research.
Discussion
There were several limitations to the literature review. First and foremost, with the implementation of simulation in healthcare, little information is available related to how simulation can help in the pre-employment process. It is also recognized that the pre-hire assessment process in each article reviewed differed from study to study. Additionally, many of these articles were conducted within a single hospital, which may not accurately represent hospitals nationally or globally. It is also noted that many of the hospitals studied were large hospital organizations, leaving the rural or small community hospitals poorly represented. No grand claims of generalizability can be made regarding the use of pre-hire simulations.
Additionally, there were several limitations to the staff satisfaction surveys. There is a large portion of the nursing population that is working under an associate’s degree. However, only 6.7% of our responses represented that population. It is also noted that the male nursing population was not well represented, neither was any ethnicity other than White / Caucasian. All of our responses were from fulltime employees and therefore underrepresent all part-time or PRN (as needed) employees. While it is noted that the number of staff members at Dixie Regional Medical Center is limited, we would ideally like to expand our survey population in the future. We believe it will enable us to collect a more accurate data compilation of staff satisfaction ratings regarding pre-hire simulations.
There is a lot of room for future research when it comes to using simulation, specifically in the pre-employment process. Ideally, we would like to see more future research studies conducted having the same parameters, guidelines, and assessing strategies to generalize and expand the amount of data available. Using standardized simulations, assessment tools, staff satisfaction surveys, etc., that are more qualitative will aid the implementation of more persuasive and evidence-based pre-hire simulations nationwide.
Conclusion
Accurately predicting a new graduate’s nursing success leads to decreased turnover rate, reduced fiscal stress and hiring expenditure, and increased satisfaction and quality of staff in the work environment. Pre-hire simulation results in a more rigorous approach to hiring new graduate nurses and successful assessment of situational, clinical and behavioral measures in these candidates. It is hoped that as a result of this literature review and our future publications regarding our findings, future research will aid the implementation of pre-hire simulation in nursing practice, better preparing new graduates to be safe and effective nurses in health care organizations around the world.