As the pool of available and qualified nurses

shrinks, hiring the right person becomes

even more important, particularly in the

surgical services department, which has one of the

largest expense budgets in most hospitals. Although

some nursing education programs are beginning to see

the value of adding a perioperative elective, this probably

will not meet the immediate needs of many health care

facilities, especially as the United States is experiencing a

nursing shortage and nursing school enrollment is less

than the projected need.

The cost of recruiting, especially in the perioperative

area, is higher than most hospital executives realize. The

average cost of turnover can be calculated as 25 percent of

an employee's annual salary plus 25 percent of the cost of

benefits provided. Typically benefits are approximately 30

percent of an employee's annual salary. If this formula is

applied to an employee earning $30,000 annually, the cost

of hiring and training the employee is approximately

$9,750 (i.e., [$30,000 X 25 percent] + [$30,000 X 30 percent

X 25 percent]). This formula only reflects an orientation

period of two weeks, but training a perioperative

nurse can take up to six months. Given the salary of the

new nurse and the additional cost of the preceptor's

decreased productivity during training, the cost of replacing

perioperative staff members may he significantly higher

than that of other employees.

Job Profiling

One of a manager's biggest problems is determining

which RN or new graduate should have an opportunity to

learn perioperative nursing skills. Many surgical services

managers and directors have developed a sixth sense about

who will make it; however, this sense is difficult to translate

into an objective hiring method that is acceptable to

the human resources department. In addition, poor hiring

decisions may lead to human and fiscal costs, as well as

discipline, labor and customer problems.

Job profiling is a method of validating the intuition of

surgical services managers and directors. A job profile

determines behavioral characteristics required for given

positions. These characteristics or traits often are seen in

top performers in the facility, but they may be difficult to

articulate. The job profiling process, when used in conjunction

with other human resource methods (e.g., a

structured interview), is objective, reliable, repeatable, and

relatively inexpensive when compared to the cost of one

poor selection.

Consultants, counselors and trainers have used behavioral

methodology for improving communication and relationships

and managing conflict successfully for many

years. One study of nurses found that there was a significant

correlation between personality and job satisfaction

among intensive care, non-intensive care, and perioperative

nurses.4 This research was initiated because of high

turnover rates among perioperative nurses and the educational

costs associated with developing competent replacements.

 Another study found that low job satisfaction

among nurses is correlated to high turnover.

Creating a Job Profile

Although many tools can be used to create a job profile,

one of the oldest and most researched behavioral

models is the dominance, influence, steadiness/supportiveness,

and compliance/conscientiousness (DISC) model.

The DISC model used today was developed by William

Moulton Marston. It describes four quadrants that are

placed at right angles to each other (http://xrl.us/DISC4Quadrants).

Creating a job profile using the DISC methodology

requires creating a DISC model for the job position that

uses a work environment or role behavior tool. These

tools ask about behavioral characteristics required to succeed

in the position (e.g., job requires following directions,

task-oriented concentration, expediting action,

analysis of facts and data). An analysis of this information

helps create a profile of behavioral characteristics required

for the position. Individuals selected to complete the tool

usually are managers or nursing staff members who are

considered to be top performers. These top performers can

be determined based on performance criteria developed

for competencies or evaluations. Although the job profile

can be created for a generalist in larger ORs, where differentiation

has created different behavioral types, profiles

should be developed for specialty team members. If there

are discrepancies in the DISC profile created by the work

environment or role behavioral tool, group members can

resolve them by examining requirements and identifying

competencies that demonstrate required behaviors.

In one profile, composite characteristics identified by

perioperative RNs in three facilities and behavioral characteristics

expected by perioperative managers mirror one

another. This profile indicates that the ideal perioperative

nurse will display a calculated, conservative approach to

the job in the dominance factor of the DISC model. The

influence factor is indicative of a nurse who is matter-offact,

factual and logical. The steadiness/supportiveness factor

shows a nurse who is stable, steady and consistent; and the

compliance/conscientiousness factor describes an individual

who is systematic, accurate, and exacting.

assessment tool is used to compare the newly created

profile to known top performers in the organization.

The behavioral assessment tool consists of simple

written surveys that require approximately 10 minutes

for the employee to complete. It also acts as a validation

method because it compares organizational

achievers to the profile.

Applying the Profile to Candidates

After the profile has been validated using staff member

information, it can be applied to candidates interested

in perioperative training. Job profiling is not meant to

replace the regular interview process. It is an additional

tool to help the organization and the candidate make

decisions. If a candidate feels strongly about working in

the OR but the profile does not support his or her being

successful in the role, the manager can talk to the candidate

about the stress of the perioperative environment

and the history of successful perioperative nurses. Rather

than being hired and beginning training, these candidates

can opt to follow a perioperative nurse for a few

days to see what perioperative nursing really entails. This

frequently will be enough to help the candidate realize

that he or she is not behaviorally suited for the perioperative

environment.

Job profiling is an objective methodology for selecting

candidates that outlines the attitudes and behaviors

demonstrated by successful practitioners. As health care

facilities hire new graduates or inexperienced personnel to

train on the job or through off-site training programs, hiring

the right individual becomes more important.

Considering how much it costs to train a perioperative

nurse, it is worth the effort to get the right person in the

right job the first time.

References

1. L Travis, "Nursing education: Where are we now, and

where should we be going," presentation given at

American Organization of Nurse Executives meeting,

Houston, October 2001.

2. H Plotkin, Building a Winning Team (Glendale, Calif:

Griffin Publishing, 1997).

3. Ibid.

4. A L Hart, "Operating Room Nurses' Personality Profiles

as Related to Job Satisfaction" (Ph.D. dissertation,

Indiana University School of Nursing, Indianapolis,

1986).

5. A Harvey, "Finders keepers: Or weathering the nursing

shortage," Today's OR Nurse 4 (February 1983) 14-17.

6. B Trimiglozzi, K Cooke, "Meeting demands for qualified

OR nurses," Today's OR Nurse 7 (July 1985) 32-34.

7. W M Marston, Emotions of Normal People (New York:

Routledge, 2000).