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From new hires to new health systems, RNs must focus on value of enculturation

Monday April 22, 2013
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When hiring nurses, Charlene Ruggiero, RN, ICU and neuro ICU nurse manager at Overlook Medical Center, Summit, N.J., said a candidate’s ability to fit into the hospital’s culture is as important as years of experience.

Finding nurses who will mesh with a hospital’s mission, values, philosophies — and even approach to care — is supremely important.

"Let’s say I have two candidates," she said. "One has 20 years experience and one is a new grad. I’m not going to necessarily automatically favor a nurse who has 20 years experience over the new grad, unless I feel the nurse would be a good fit."

Nurse enculturation is important not only for nurse retention but for optimal patient care, according to Donna Delicio, RN, MSN, CNA, oncology manager, Overlook Medical Center.

"In order to operate well within a hospital system, within other departments, as well as with your own team within a department, you have to share the same culture," she said.

Fitting well into an organization might take time. What matters is whether the nurse is open to the values and philosophies of a hospital or health system, according to Wayne Christie, RN, MSN, NE-BC, director of nursing, New York Methodist Hospital, Brooklyn.

For example, some nurses need additional technology training at hospitals that have converted from paper to computer records. It’s not whether that nurse knows how to operate in a technology-focused culture, but rather if he or she is willing to learn and work with an electronic medical record, Christie said.

"A lot of new nurses have come out of nursing school and are very computer savvy," he said. "It’s opposite for seasoned nurses, who have to step out of the paper world and now move into an electronic format. We’ve had challenges there, but what we’ve done is provided a lot of support and resources [to help them make the transition]."

Enculturation is not only important for nurses who are new to their jobs, but also for nurses who work at hospitals that are merging or have been acquired by other institutions or systems.

Bonnie Michaels, RN, MA, NEA-BC, FACHE, vice president and CNO, HackensackUMC Mountainside, Montclair, N.J., said the culture has changed since the stand-alone Mountainside Hospital was acquired and is now co-owned by HackensackUMC and LHP Hospital Group Inc., less than a year ago.

"We’re part of this big system now," Michaels said. She and other leaders within the system are working to ensure all employees are on the same page, with the same vision and mission when it comes to how they work with patients. To spread the word of the system’s philosophy and culture and engage employees, nurse leaders and managers are sharing a prepared statement with front-line staff.

Part of the statement reads: "We embrace a culture of patient-centered care, where every patient interaction is delivered with compassion, professionalism and a commitment to quality and safety. We want to be one of the premiere hospitals in New Jersey, and the hospital of choice in our community for patients, physicians and employees. And we will know we are there when our patient, physician and employee satisfaction and our quality scores exceed the national benchmarks. ... We need your commitment to excellence and active participation, as both an individual and team member."

The statement, Michaels said, helps to set the cultural tone.

"We really have new goals regarding patient satisfaction and employee satisfaction," she said. "Not that we weren’t doing it before, but now we have time frames and initiatives that we’re all working on."

Since the June 2012 acquisition, Michaels said that patient satisfaction scores have risen at the facility.

Ruggiero said ICU nurses focus on the unit’s intensity. They’re patient- and technology-focused. But Overlook’s culture puts just as much emphasis on caring for the family surrounding the patient in crisis, she said.

"If a critical care nurse can’t minister to that family as much as [he or she] does to the patient, it’s not going to be a good fit," Ruggiero said. To uncover nurses’ attitudes toward families, Ruggiero asks pointed questions during the interview, such as, "How do you feel about family visitation? How open are you to flexible visitation?"

Delicio said when she interviews nurses, she invites other members of the staff to interview the candidate as well. After all, nurses on staff also have to feel the candidate is a good fit.

She’ll also ask questions with purpose.

"You get a sense of their true values when you hear how they handle a challenging patient experience, an emotional patient experience," Delicio said.

Aisha Miller, RN, associate director of nursing, New York Methodist Hospital, uses the interview as a way to prepare nurses for the culture in the hospital’s med/surg unit.

"I always say, if you can work here in the med/surg unit, you can work anywhere," Miller said. "We’re raising the bar, every day."

Some interviewers quote directly from hospital mission or philosophy statements. During the interview, Delicio shares the PRIDE philosophy of Atlantic Health System, which owns Overlook. The acronym, she said, stands for Professionalism, Respect, Involvement, Dignity and Excellence.

Delicio and her staff look for candidates’ reactions to the PRIDE message, then watch for signs of enculturation during the orientation, she said.

There is only so much one can tell about whether a nurse will fit into an organization from the interview alone. The orientation, when nurses delve into some of their responsibilities and work with colleagues and patients, is another indicator.

"Some of the things we’re always looking at in the orientation process are customer service, teamwork, delegation, organizational skills, people being comfortable communicating upward and obviously receiving information that comes either across to them or down to them," Christie said.

For nurses who aren’t feeling the fit, honesty is the best policy, according to Miller.

"Being honest up front, knowing your limitations, and being able to articulate that is a smart way to go," Miller said. "[If things aren’t working out], we try to find the right fit ... into the organization, and the right fit into the actual department or unit in which they’ll be working."

Delicio said maintaining a positive culture within an organization is an ongoing process.

"I think you build upon the culture of the team and organization and department by always having your staff involved," she said.

That includes "good communication, as well as meeting with them regularly to discuss how better to do things and how to maintain that culture," Delicio said. "It’s more about mentoring, coaching, collegially working with staff, and, again, growing that culture together. It’s not a top-down approach."

Lisette Hilton is a freelance writer.


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Finding the right fit

Jen Schmitz, RN, MSN, nursing faculty manager, Kaplan Test Prep, helps nurses transition from graduation to their first jobs and hires faculty for Kaplan. She offers these tips to help job-hunting nurses determine whether they’ll fit into an organization’s culture.
• Know yourself. Take an inventory of what’s important to you in a work environment.
• Study the employers. Once you know what you want, focus on potential employers’ approaches to teamwork, collaboration, leadership and work environment. Do your research, listen and observe before and during the interview process. Does the leadership have a top-down approach? Is teamwork or autonomy the emphasis? Know the institution’s mission and values.
• Ask questions. “What is the culture here?” Then, drill down, asking questions such as, “Is there self-scheduling or the scheduling set?” In ideal situations, talk with a nurse who works in the hospital about what it’s like to work there.
• Look for support mechanisms. Are there willing mentors? What about internship programs or ample orientation opportunities? Research suggests the more support there is in an environment, the more successful nurses are in becoming part of the environment’s culture.