Hiring Nurse Leaders From Within


The world of healthcare is changing rapidly, requiring new thinking and new approaches to succeed in an increasingly competitive and bottom-line driven environment.

Since healthcare is a service-driven industry, people are the critical component in delivering the broad range of services that go into care delivery.

Finding, attracting and retaining the best and the brightest staff members across a variety of specialties is obviously important. But there’s a definite balance to be struck between nurturing longevity through loyalty driven by opportunities to learn and grow and ensuring that the organization is continually infused with new ideas and fresh approaches.

“In today’s changing healthcare climate, it’s imperative to have a robust workforce in order to meet the diverse needs of the patients,” says Elizabeth Asturi, MSN, RN, NE-BC, associate chief nursing officer at Texas Health Presbyterian Hospital, Dallas.

“There are advantages to hiring from both within and outside of an organization for a myriad of reasons.”


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Pros & Cons

One of the big benefits of hiring from within is ensuring culture fit, says Asturi.

“In today’s healthcare market, the culture fit is just as important as the individual’s clinical skills,” she says.

“In fact, many employers hire for a culture fit and believe they can look for opportunities to improve skills based on their current learning needs.”

Others agree that hiring from within holds promise in most situations.

David Dworin, is a consultant with Dworin Consulting (http://www.dworin.com/), in New York City, where he works with professional service firms.

“In my experience, hiring from within is almost always better than bringing in ‘new blood’,” says Dworin, “but it comes with some big caveats that most organizations miss.”

The benefits, says Dworin, include spending less time teaching new people processes and culture and demonstrating to employees that there is a future with the organization.

Benefits aside, Dworin and others admit that hiring from within also has some downfalls.

Striking a Balance

The big caveats to effectively hiring from within, says Dworin, have to do with culture and churn.

“You need a culture that believes in continuous improvement and continuous learning, so that you’re always willing to try new things, always improving and always picking up on best practices from outside the organization,” he says.

In addition, “you have to be willing to create churn at the top by aggressively managing poor and mediocre performers out of the organization, otherwise a layer of clay develops where those at the bottom feel like they’ll never be able to grow and that your promote-from-within policy is in name only because there are never any opportunities for promotion.”

Of course, Asturi adds, in situations where the organization may wish to – or need to – change its culture, looking outside for an infusion of fresh insights and new perspectives can be a big boon.

Ultimately, notes Tony Rutigliano, senior vice president at Caliper, based in the New York City area, straying too far to one or the other end of the spectrum can be problematic.

“If you bring people in only from the outside you send a message to employees that, if they want to advance, they have to look elsewhere.”

On the other hand, he says: “The problem with saying we’re not going to go outside is you’re delimiting your chance of finding the absolute best person.”

The best philosophy, he believes, is one that says: “When we can’t find a candidate internally is when we will start looking outside.”

The decision, says Rutigliano and others, should be based on the requirements of the position and the skills, experience and background that candidates – internal or external-have to contribute.

“We truly believe there is value in doing both,” says Isaac Rosedale, LNHA, executive vice president for CommuniCare Family of Companies (http://www.communicare.org/) in Elizabethtown, Ky.

“When you hire and promote from within, not only are you better able to understand a potential team member’s clinical capabilities and execution system as it relates to our high standards, but the culture within our healthcare centers makes the difference between a good patient experience and a great one.

“In terms of benefits to the organization, it’s sensible to promote and hire those who are familiar with the organization’s systems and processes.”

But, he adds: “Having said all of that, there are certainly benefits to bringing in staff from outside the organization as well. We can always benefit by bringing in new ideas, fresh and passionate talent, that has the ability to rejuvenate a team that may need that injection of energy.”

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Practical Considerations

When it comes to making decisions about hiring from within versus recruiting from outside the organization, says Ann Latham, president of Uncommon Clarity, Inc., a Massachusetts-based consulting firm. There are two key considerations, she says:

All things being equal, do you want your employees to believe you value their service and want to provide them with opportunities for advancement and growth?

How does your need for continuity and providing internal opportunities compare to your need for fresh ideas?

“Keep in mind that outside talent often appears shiny, new and wonderful because you’ve yet to see the faults and idiosyncracies,” Latham says. “If that happens too much, ask yourself if you’re being fair to your employees, recognizing their accomplishment and giving them opportunities to excel.”

Finding the right balance between internal and external talent is key agrees Joseph Tomaino, executive vice president of Catholic Health Services of Long Island (http://www.chsli.org).

“The question of whether it is better to hire from within vs. outside is dependent upon the situation a leader is presented with,” says Tomaino. “As with many things in life, what you want to achieve is balance.

“If a unit or facility has had a long history of internal promotion and has not brought in new hires with a new external perspective, then one should be inclined to bring in some new blood.

“On the other hand, if an organization is frequently experiencing turnover and change, the emphasis may be placed on promoting from within to reward and encourage longevity and stability.”

Internal staff can certainly demonstrate the ability to stay current on external trends and best practices, notes Tomaino, by attending conferences, participating in continuing education and obtaining advanced degrees. Coming from within does not necessarily


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Another factor to consider when looking at the equation is how much participation staff have made in external conferences, continuing education, and obtaining advance degrees.

Even if there has been a track record of internal promotion, if staff have demonstrated the ability to remain current and open to new external ideas through conferences and education, then that would be a mitigating factor against bringing in outside candidates.

The bottom line?

“As with most business decisions,” says Dworin, “the answer comes down to ‘it depends’.

“If you do it right, I see promote-from-within policies as the superior option, but too often organizations forget about the caveats that go along with it and bring in ‘new blood’ to solve the problems that come from an organization that stops learning, stops trying new things and allows poor performers to spend too long in senior management.”

Latham agrees. “There is no right answer, but there is one imperative,” she says.

“Only hire candidates who are a strong fit for the position. Being energized by your job and able to do it well day in and day out are far more important than where you’ve been or what you’ve done.”

Lin Grensing-Pophal is a freelance writer.


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