Providing quality care begins with selecting the right people to join the home health agency team. Unlike many healthcare settings, home health professionals work in patients’ homes, often independently, serving as the face and voice of the organization. Their competence, reliability, and compassion directly shape patient experiences, regulatory compliance, and overall agency performance.
Hiring the right staff is not simply about filling open positions. It’s about building a workforce that aligns with the agency’s mission, values, and standards of care. This article will help organization leaders hire the right staff for the right position, a crucial first step to improve outcomes for both patients and the organization.
Why Smart Hiring Practices Matter
Hiring the right people for the job directly impacts every aspect of care delivery. Skilled and dependable staff can be relied on to offer consistent high-quality services that improve patient safety, satisfaction, and outcomes. They help reduce rehospitalizations, ensure regulatory compliance, and create and strengthen trusting relationships with patients and families. In contrast, poor hiring decisions lead to increased turnover, service gaps, the need for costly retraining, and potential compliance issues. Because caregivers and clinicians work independently in the field, agencies rely on their judgment, professionalism, and accountability. Thus making the right hiring decisions from the start isn’t just good practice. It’s essential to maintain stability, the agency’s reputation, and overall quality of care.
Reasons for Staff Turnover
According to a McKnight’s Senior Living article, the turnover rate for certified nurse aides (CNAs) was a dismaying 54.8% (Gaivin, 2022). The turnover rates for nurses were slightly lower, with licensed practical nurses (LPNs) at 41.3% and registered nurses (RNs) at 46.2%. All three rates have increased since 2021.
People don’t usually walk away from a job solely because of pay. Studies show several common more complicated reasons why employees choose to leave their positions. These are some frequently cited reasons for resigning:
- Limited or poor relationship with immediate supervisor
- Lack of autonomy and flexibility
- Feeling tired of the status quo and stifled when attempting to make improvements
- Feeling overlooked or undervalued for individual talents and contributions
- Exhaustion, coupled with long hours and overtime
- Compensation not commensurate with the demands of the work
- New job might offer a promotion or opportunity for new challenges
It’s not just existing staff who quit. About 57% of caregiver turnover occurs within the first 90 days of employment (Redd, 2022). Reasons given why new hires depart early are discovering the job isn’t what they expected, they don’t like their manager, or they found the training to be inadequate. The director can forestall some of these issues by making well-informed hiring decisions and also being very upfront about both the challenges and the rewards of the work.
The Hiring Process
Ideally, the hiring process begins during recruitment when the prospective staff member and employer have their first contact. Both the job applicant and the employer receive an initial impression of each other based on image, attitude, communication style, and the exchange of information. It must be emphasized that both applicant and prospective employer are making judgments at this point that could influence their potential future working relationship.
Next comes completion of the job application, interview, reference check, and pre-employment health screening. The hiring manager should ensure the process is completed as quickly and efficiently as possible. An organization could fail to hire some great candidates who accept another position where decisions are made more quickly.
Pre-Screening
Some organizations conduct a screening before the formal interview. It should be brief and allow the leader to determine if the applicant will be scheduled for a comprehensive interview that requires significant time and energy. The screening process may be delegated to another individual or third-party organization, as long as criteria are established to structure the process. Here’s a possible approach to the screening process:
- Offer the applicant a handout when the application is received, explaining salary range for the job and the requirement for a criminal background check and Drug-Free Workplace Program. The organization completes a checklist based on the applicant’s responses.
- If another employee conducts the pre-screening, he or she must know what skills are needed for the position, such as education, experience, and qualifications for the job.
The Interview
Once the candidate has been vetted and appears to have the required skills for the job, he or she is invited for an in-person interview as soon as possible. The interview is a critical part of the hiring process. It determines if the candidate possesses the qualities, talents, and skills needed for the job. It can also help evaluate if the candidate will be a good fit for the organization’s culture. Remember, this is also the candidate’s opportunity to assess the organization, so staff also want to make a positive first impression.
Here are some suggested steps for the hiring process:
- Choose someone personable to greet the candidate and help ease any nerves. Engaging in light conversation and offering a beverage can help create a warm welcome. A candidate who is kept waiting too long or treated dismissively may leave before the interview even starts.
- Conduct the interview in a quiet environment that allows both parties to focus on the interchange. An office in disarray or with distractions such as a ringing phone and knocks on the door sends a strong message of disorganization.
- Smile, be courteous, and pay attention to the interviewee. Keep in mind the goal of getting acquainted and helping them feel comfortable. This will help them be more open during the interview. If the director begins by bombarding the candidate with interview questions, the person may become tense and guarded. Terse yes/no responses can mask the candidate’s true qualities.
- Share what the job means. This is the organization leader’s opportunity to relate the story of the organization in a personal way by sharing its history, mission, goals, and vision for the future. Gauge the candidate’s response. The interviewer should be clear about what the role entails and honest about job requirements, working hours, benefits, and salary. Pay attention to any verbalizations or body language from the candidate that indicates positive enthusiasm or a lack of affect (Pavlou, 2023).
Utilize a behavioral-based interview during the process. By revealing the behaviors candidates default to, the nurse leader can better predict how the candidate will perform in the future but can also reveal the candidate’s character and talents. AAPACN has developed the Interview Template tool to assist with this type of interview.
Characteristics of a Strong Candidate
Hiring staff with staying power begins with finding strong candidates whose characteristics mesh well with the organization. It goes beyond competency. Characteristics to look for in a strong candidate, as well as tips to strengthen these characteristics further, are as follows:
- Alignment with organization mission: Once the organization’s mission has been shared, does the candidate’s belief system correspond with the mission? Is he or she inspired?
- Experience in the role: Does the candidate need extra training? Be transparent regarding the requirements of the position and ensure that resources and training are there when needed to ensure the candidate’s success.
- Complement current team culture: Will the candidate fit in with the existing team or will he or she cause tension?
- Promote collaboration and dignity: Does the candidate appear compassionate and reliable? Share processes and expectations regarding communication and maintaining patients’ dignity.
- Problem solving: Is the candidate a problem solver? Ask the candidate to tell you about a problem they had and how they approached it. Offer candidates some examples of how the organization helps ensure the safety of patients and employees through creative problem solving.
- Enhance patient quality of life: Does the candidate exhibit the characteristics needed, such as empathy, to maintain or improve quality of life for the patient? Explain the expectations of the open position.
Beyond the Conversation
Although the questions are certainly important, the interview is not just about how the candidate can converse. Paying attention to the candidate’s body language can also help assess their confidence, ability to work as part of a team, and trustworthiness.
Facial expressions can offer insight into how a candidate feels about a question. Genuine natural smiles show an interest in the job. Good eye contact shows confidence and comfort, as well as a willingness to engage with others.
A candidate’s posture can show their interest in the position. Those interested will most likely sit up straight with an open posture facing the interviewer. Although the candidate may be nervous and fidget a little, increased restlessness may indicate a lack of confidence or social awareness.
When a candidate pauses to consider a question, it shows thoughtful consideration of the question. But when the person has a chance to speak and doesn’t ask any questions about the organization or the job, it may show a lack of interest.
By prioritizing candidates who align with the organization’s values and demonstrate both technical skill and compassion, agencies can create a build a foundation for staff who provide better patient outcomes, ensure stronger compliance, and are less likely to resign. In a field where trust and care unfold literally inside the patient’s home, the right hire makes all the difference.
References
Gaivin, K. S. (2022, August 1). Nursing home staff turnover up 25 percent from last year: survey. McKnight’s Senior Living. https://www.mcknightsseniorliving.com/home/news/business-daily-news/nursing-home-staff-turnover-up-25-percent-from-last-year-survey
Pavlou, C. (2023). How to reduce new hire turnover. Workable Technology Limited. https://resources.workable.com/tutorial/new-hire-turnover-rate
Redd, J. (2022). The 5 most preventable causes of 90-day caregiver turnover. Activated Insights. https://activatedinsights.com/articles/the-5-most-preventable-causes-of-90-day-caregiver-turnover/
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