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468 JONA • Vol. 33, No. 9 • September 2003
With competition increasing for scarce personnel re-
sources, recruitment and retention processes must
be efficient and effective.The author reports the re-
sults of an extensive study of recruitment processes
and systems in acute care hospitals throughout the
United States and the major recruitment factors that
lead to job choice decisions by staff nurses.
The chief nurse executive is sitting in her office
on the sixth floor looking over a list of 180 va-
cant staff nurse positions, wondering what she
should do about her shortage of RNs.The chief
executive officer calls and asks when she will
be ready to open the new 10-bed unit. No
sooner does she hang up, when the chief of
surgery calls complaining about short staffing
in the intensive care unit (ICU).
In the human resources department, no one is
answering the phone and several letters from
nurses interested in staff positions lay unan-
swered. One is accidentally knocked into the
waste basket. There is no one available to re-
turn the calls from applicants left on the voice
mail system during the last week. On a med-
ical-surgical unit, a registered nurse applicant
has been waiting 30 minutes to see the nurse
manager for a prescheduled interview, while
the manager of the ICU, in the middle of an-
other interview with an applicant, leaves the
interview for 15 minutes with no explanation.
How frequently do these occurrences happen?
Unfortunately, according to my research data, the an-
swer is: all too frequently. Findings from a study
of recruitment processes in 122 hospitals throughout
the United States uncovered an astounding number of
problems in the nurse recruitment processes in hos-
pitals with large numbers of staff nurse vacancies.
Data were collected in 10 geographic locations
throughout the United States: Los Angeles, Calif; Ft.
Lauderdale, Fla; Miami, Fla; Hartford, Conn; Pitts-
burgh, Penn; Seattle,Wash; Dallas,Tex; Detroit, Mich;
Chicago, Ill; and Kansas City, Kan. A total of 122
acute care hospitals were included in the study.
These hospitals were subdivided in groups of four or
five within a competitive market area within each of
these cities.
A total of 30 market areas were identified. Ex-
cept for two of these areas, there were four facili-
ties in each. The two remaining areas had five
hospitals in them.The number of competitive mar-
ket area hospital groupings varied per city-some
cities had three market areas and others only one.
Each area was experiencing significant nurse short-
ages according to the state nursing organizations
and verified with personal contacts with nurse ex-
ecutives in each of these areas.
The Process
For this study, data collector applicants refers to the
nurses who made application and interviewed with
the study hospitals. They will be referred to as appli-
cants in this article. Recruiter refers to anyone who
interacted with the applicants in the application/in-
terviewing process (ie, recruiter, manager, vice presi-
dent, coordinator, supervisor, staff nurse, secretary).
Applicant Data Collectors
Ten nurses with a either a baccalaureate or associate
degree in nursing and work experience varying from
JONA
Volume 33, Number 9, pp 468-477
©2003, Lippincott Williams & Wilkins, Inc.
Recruiting Nurses
The Problem Is the Process
Beatrice J. Kalisch, PhD, RN
AAuutthhoorr aaffffiilliiaattiioonn::
Director, Nursing Business and Systems,
Titus Distinguished Professor of Nursing, School of Nursing, Uni-
versity of Michigan, Ann Arbor.
CCoorrrreessppoonnddiinngg aauutthhoorr::
Beatrice J. Kalisch, PhD, RN, School of
Nursing, University of Michigan, 400 Ingalls, Room #4170, Ann
Arbor, MI 48109-0482 (bookmana@aol.com).
JONA • Vol. 33, No. 9 • September 2003 469
newly licensed nurses to nurses with 21 years of ex-
perience were selected to be the data collector ap-
plicants for this study. Their credentials qualified
them to be medical-surgical and/or critical care
staff nurses. To avoid the confounding variables of
gender and race, all applicants were female cau-
casians who applied for and completed an in-person
interview for a staff nurse position.
These applicants held staff nurse positions at
the time they participated in this study.Their nurse
managers were aware of their participation in the
study and were willing to provide a reference if re-
quested. In exchange for their assistance, these man-
agers received a general report (no specific hospital
names or geographic areas) of the study results.
Applicants received financial reimbursement for
their participation in the study. Both the applicants
and their managers committed to the maintenance
of the confidentiality of the application and inter-
viewing organization.
Application/Interview Process
The procedure for applying and interviewing at the
study hospitals was standardized. In the first step,
the applicant sent a typed and clearly written letter
of inquiry and resume to the organization, indicating
how she could be reached by telephone, mail, and e-
mail. If there was no response to the letter of inquiry
after 3 weeks, the applicant placed a phone call to
the recruiter in the organization. If there was no re-
sponse from the organization, the applicant contin-
ued to call the organization every other day for 2
weeks.
Throughout the process, the applicants were
asked to be available when the recruiter said they
would call back and to return phone calls within 24
hours. No matter how they were treated, the appli-
cants were instructed to respond politely and to
continue to call until they received a response.
After completing the preinterview steps (ie, con-
tacting the hospital, scheduling the interview), the
applicants were asked if they would choose to in-
terview at the organization and the reasons behind
their decision.
All of the organizations eventually expressed
interest in interviewing the applicants. Appoint-
ments were made with the recruiter for on-site in-
terviews.The research protocol required that each
applicant arrive on time and interview with or ask
to interview with at least 3 individuals or
groups—the recruiter, the nurse manager (or man-
agers if being considered for more than one unit),
and staff nurses on the unit. If the recruiter or man-
ager did not arrange for the applicant to speak to
staff after one request, the applicant was instructed
to ask up to two more times and then stop asking.
If not provided, the applicant was instructed to
request information on compensation, benefits,
staffing mix and levels, model of care, and educa-
tional programs. They also toured the facility, if in-
vited, and visited the hospital cafeteria if it was
open. If the applicant was offered the position, she
was instructed to decline it after a 2-week wait, giv-
ing time for someone in the organization to follow-
up with the applicant.
Questionnaires
The main questionnaire was divided into six sec-
tions: (1) pre-interview contacts, (2) the interview
experience, (3) the strengths and weaknesses of
each interviewer (eg, recruiter, manager, staff),
(4) follow-up after the interview, and (5) a narrative
description about the interview experience (ie,
thoughts, perceptions, and emotional responses).
In addition, applicants completed a separate ques-
tionnaire in which they were asked to identify
which hospital of the four or five they applied to,
they preferred for employment and why.
The questionnaires completed by the applicants
were developed in a pilot study. The initial question-
naires were tested with one facility, then refined
based on the results of that application process.They
were then used in another facility and further re-
fined. The narrative descriptions that were com-
pleted in each of the pilot facilities were examined
closely for themes and issues not addressed in the
standardized questionnaire and added as appropri-
ate.This process involved applications to seven facil-
ities before the questionnaire was finalized. A focus
group of nurse recruiters, managers, and human re-
source specialists was used to determine the validity
of the questionnaire. The group had only a few
minor suggestions.
The applicants also assembled the written mate-
rials they received. These items included letters, re-
cruitment brochures, written information about the
position, compensation schedules, and benefit de-
scriptions.The applicants rated them on their effec-
tiveness (poor, average, excellent) according to es-
tablished criteria.
Preinterview Contacts
Many serious problems occurred during the prein-
terview stage of the process, ranging from no re-
sponse to letters to extensive telephone tag (Table
1). Furthermore, the overall quality of the letters,
470 JONA • Vol. 33, No. 9 • September 2003
written brochures, and other materials was fair to
poor (Table 2).
When asked if they would “choose to interview
with this hospital if you were in a real-life situa-
tion?”, only 29% of the applicants said “yes, defi-
nitely” while another 22% replied “maybe, not sure.”
Of the 97 hospitals that applicants might have
turned down, five facilities ultimately were selected
as the first choice for employment in their market
grouping, underlining the critical impact of these
early impressions.This also demonstrates that the de-
cision to interview in any given organization is
based on the very small amount of information that
applicants receive early in the job choice process.
Besides previous images they held of the organiza-
tion (which occurred in only 9% of the cases), the
initial application decisions were based solely on the
quality, nature, and timeliness of letters; phone con-
tacts; e-mails; and the quality of printed brochures
and other materials.
Table 1. Preinterview Factors Deterring Applicants from Interviewing
Characteristic N (%) Example Applicant Comments
No written response to 30 (25) There was no response to my letter.
initial letter of inquiry
There was no response to my letter of inquiry, although it was definitely
received by the hospital and was used by the recruiter for reference dur-
ing my interview.
No letter or note with 19 (16) There was no letter and no personal notes. It was a 2-page very unappeal-
letter of inquiry ing initial materials sent brochure printed on poor quality paper. Inside
was an application for employment but no return envelope.
Delayed response to initial 6 (5) I finally got a response, but it was 27 d after I had written. In the mean-
time, I called.The letter made no mention that I already had an interview
set up. I thought maybe my letter was delayed getting there, but the sec-
retary said it was received more than 2 wk before.
Letter sent asking candidate 5 (4) I was offended that they wrote to me and told me to call them. If they
to call them really were interested, it seems like they would have called me. I had my
phone number right there.
No response or delayed 86 (71) I called twice to make an appointment, and the first time the message was
response to telephone not answered.
inquiries I called for an interview appointment, and the request was met with an
“ooh” by the secretary.After some hesitation, the secretary took the re-
quest and stated she would get back to me that day to let me know if it
could be arranged. I had to follow up because I never heard back.
Phone answering machine 94 (77) I could never reach a real person. It was so frustrating.
Extensive telephone tag; 101 (83) She said to call back between 4 and 5 PM. I tried at least 6 times, but to no
recruiter not available when avail. I felt they weren’t interested.
told to call back
Placed on hold for long 26 (21) When I called for an interview appointment, the hospital operator kept
periods of time getting busy signals on two separate lines to the office.After approxi-
mately 5 min, she put me on hold, and when she came back, she told me
that she went over to the office and yelled at them to get off the phone.
After another 5 min on hold, the human resources secretary did arrange
an appointment.
Reluctance or refusal to set up 39 (32) When I called for an interview, I was told that they do not do interviews
an appointment for an without a completed application “because we get so many applicants,
interview we can’t possibly interview all of them.” She told me to put a note on
my application as to when an interview would be best. I had to call
three times to confirm the time with the human resources secretary.
I called 3 times, but they just said to come in whenever I got there
[from Detroit to California].
The recruiter said I didn’t need an appointment. Just stop by when you get
a chance.
I had to really insist to get an appointment, even though she knew I was
traveling a considerable distance.
Curt telephone manner 28 (23) When I called for an appointment, the phone was answered “employment.”
They were abrupt.
JONA • Vol. 33, No. 9 • September 2003 471
Table 2. Quality of Letters and Written Materials
Excellent, Average, Poor,
Effectiveness Criteria N (%) N (%) N (%) Example Applicant Comments
Tone (ie, friendly, welcoming) 44 (36) 31 (25) 47 (39) The letter was written in a very inviting way. It
sounded like they knew me!
Writing (grammar, spelling, 36 (30) 37 (30) 49 (40) I was amazed at how many misspellings there were in
message, etc) the letter they sent me, including my name and the
street I live on.
The letter was written very poorly—it was curt and
didn’t contain much information at all.
Quality of information 32 (26) 67 (55) 23 (19) No, or poorly developed, explanatory materials, such
as lists of benefits and salary schedules.
I really questioned whether this salary information
was honest.Why would they have to hand write
such a document unless they wanted to change it
at a moment’s notice?
The benefit package was poorly written and was so
general it had no real meaning.
Customization 7 (6) 64 (52) 51 (42) Form letters, many simply copied; salutations that did
not include the candidate’s name (Dear Madam), or
the candidate’s name was handwritten.
The letter mentioned something from my resume,
which made me feel that they were interested
in me.
Extent organization sold 6 (5) 20 (16) 96 (79) Message(s) that not only did not sell the organization
to the candidate but also sometimes unsold it (al-
though there isn’t much of a social life here in...we
have a great hospital).
Appeal 21 (17) 64 (52) 37 (30) I wasn’t impressed with the quality of the letter or
the explanations of the benefits.They didn’t look pro-
fessional.
The vice president of nursing signed the letter sent
to me.
Paper stock, logo etc. 27 (22) 54 (44) 41 (34) The brochure looked amateur, cheap looking.
Clarity of how to contact 61 (50) 6 (5) 55 (45) There was no telephone number or e-mail address to
organization contact them.
The Interview Experience
The interview process phase involved what applicants
experienced once they started to travel to the hospital
through completion of the interview. This included
locating the hospital, parking, physical facilities, inter-
action with information desk personnel, whether the
applicant was expected, waiting times, testing, length
of interview, and interview environment.
Directions and Parking
In the majority of the situations, the applicant had to
request directions to the hospital. Some applicants
indicated that they received helpful comments such
as “Lanes to get in ahead of time were given” and
“Stop lights were correctly counted.” Others, how-
ever, were given inadequate and frustrating direc-
tions. One applicant noted,“I thought I was lost be-
cause of a lack of street signs.”
Once the applicants found the facility, the next
task was parking the car. Applicants were not only
concerned about where to park, but also assessed
the ease of parking for employees.Although parking
was not a problem in many situations (“Ramps were
well lit and security personnel were visible,” “free
parking for employees was mentioned as a selling
point”), other applicants noted issues of concern
such as:
• Parking areas were not well lit and no security
was visible.
• The parking lot for employees was gravel and
muddy and located across the street.
• Employee parking was in one of two
places—a ramp at the hospital with a 2-year
waiting list and quite expensive, and a ramp
at a nearby shopping mall which cost 77
cents a day but included a 5-minute shuttle.
The recruiter warned me to check into other
hospital’s parking situations. I presume this
was better.
472 JONA • Vol. 33, No. 9 • September 2003
In addition to finding parking, applicants were
uniformly “insulted”when they had to pay their own
parking fee for the interview. This occurred in 39%
of the cases.
Physical Facilities
Applicants were impressed by large, substantial, and
attractive hospital facilities. However, this factor did
not outweigh other elements in the interviewing
process. Applicants were not bothered by hospitals
with major construction areas except when they
could not find the entrance or had difficulty walking
into the facility. They were negatively affected by
dingy lobbies, dirty and/or unkempt hallways and
rooms, odorous bathrooms, and tight work spaces
(“The lobby was dingy and really dated. My immedi-
ate thought was,‘How successful is this place? Will
my job be secure?”).
The applicants placed more emphasis on the pa-
tient units where they would be working.
• The rooms were very small and nurses had to
crawl over equipment to get to the patient.
• The units were extremely attractive and spa-
cious.There were many areas for group meet-
ings.
• The patient care areas were extremely clean
and well kept. Noise levels were minimal.
Surprisingly, 6% of the applicants mentioned the
location and quality of the nurse executive’s office
(“I figured if the top nurse is located in the basement
by herself that nursing must not rate very high
around here”).
Information Desk Personnel
The first contact for the applicant was the hospital
information desk personnel. Many were staffed by
volunteers as determined by their uniforms and
badges. While generally pleasant and friendly, they
often did not know the location of the personnel/
human resources department.
• Two elderly volunteers told me to go one way
but when I didn’t find the office, I asked some-
one else who said it was on the other side of
the hospital.
• An elderly lady at the desk responded to my
asking about where the human resources de-
partment was with,‘Well, they usually require
an appointment.” When I told her I did have
one, she sounded surprised. I felt that this was
an indication they were not very accommo-
dating to nurses seeking employment.
Interview Location(s)
In most cases, the applicants went to the human re-
source (HR) office first. The walk to HR was often
past kitchens and dirty hallways which, along with a
lack of signage, did not create good first impressions
with the candidates.
• The walk to HR was down a very long aseptic
looking hallway. I was later told it was 300
yards.
• There were no clear signs to HR.
Reception
Whether the applicant was expected by the facility
at the designated interview time ranged widely from
the researcher being present when the applicant ar-
rived (81%) to not being expected by anyone (19%).
There were occasions when the recruiter who made
the appointment was unavailable and another re-
cruiter scurried to fill in at the last minute.
In 55% of the interviews, the recruiter was ex-
pecting the candidate but no interviews had been
set up with the managers of the units being consid-
ered.This resulted in some applicants (18%) not hav-
ing the opportunity to meet with the nurse manager.
For example, one critical care nurse applicant flew
from one end of the country to the other to inter-
view in a well known medical center only to have no
one available for the interview.This applicant called
the researcher and asked what to do. She was in-
structed to page the director of critical care because
she was interviewing for a position in that specialty.
The director was “delighted”to see the applicant and
shocked that the oversight had happened. Other
applicants noted:
• The receptionist gave me the impression I was
not expected as she asked when and with
whom I had made the appointment.
• Even though I had a prearranged interview,
when I got there, the secretary didn’t know
who I was. She paged the recruiter once but
refused to do it again or to call anyone else to
see me. This was despite me telling her I
was from 2500 miles away!
• The nurse manager looked at me when I ar-
rived on the unit and said she had no time to
interview me. She said I was to interview with
the assistant manager. I waited 65 minutes
for her.
Waiting Times
The applicants waited to be seen by interviewers
from 1 to 90 minutes. In the later case, an applicant
JONA • Vol. 33, No. 9 • September 2003 473
had what she said was an excellent interview with
the nurse recruiter. She then was sent to a critical
care unit to interview with the nurse manager; she
waited in a sitting area for 1 hour.A physician having
lunch in this waiting area finally said to this appli-
cant,“You know what is going on here, don’t you?”
The applicant answered, “No, what?” “They don’t
want you on this unit—all the staff are ____ —and
they want to keep it that way.”
After another 30-minute wait, the applicant was
finally interviewed. However, she encountered nu-
merous obstacles. Comments from the manager in-
cluded “You have to work every holiday your first
year,” and “We only have openings on straight nights”
(which was not the case according to the recruiter).
Yet this same facility had over 400 open positions for
RNs, many of which were in their other critical care
units.
The applicants also noted that while they
waited, they could see the person with whom they
were supposed to be interviewing:
• I sat there 20 minutes waiting and watching
the recruiter sip coffee.There was no apology
offered for being late.
• I could hear her on the phone talking about
last Saturday’s date and this was 25 minutes
after my interview was to start.
Testing
Many hospitals required a medication test prior to
employment.Applicants reacted negatively to this re-
quirement in certain circumstances. For example,
one applicant said,“I walked into the office for my
interview and the receptionist just handed me a med
test and said the recruiter couldn’t see me until I had
finished it and she had scored it.”
Lost Applications
It was surprising to find that in 21 of the 122 hospi-
tals the applications and/or resumes provided by the
applicant were lost either temporarily or perma-
nently.
• When I got there they couldn’t find my appli-
cation or my resume.They insisted I must not
have sent it. A few minutes later I spotted it
myself on the corner of the recruiter’s desk.
• They didn’t have my resume—it got lost ap-
parently.
Length of Interview(s)
The interview lengths ranged from 5 to 95 minutes.
Not surprisingly, applicants evaluated the short in-
terviews negatively. They felt that the organization
was not interested in them, even though they re-
ceived a job offer.This was especially true when the
interview was obviously cut short for another (more
pressing) demand:
• I felt really unimportant and disregarded when
the manager got a phone call and immediately
got up and said ‘I have to go. The vice presi-
dent wants to see me. I think we have covered
everything.’
None of the applicants complained about the in-
terview(s) taking too much time.
Interview Environment
In all of the interviews, only two applicants were
offered coffee or refreshments of any kind. The
most positive evaluations occurred when the re-
cruiters talked to an applicant at a table or pulled
away from their desks and talked without barriers
between them. Many times, the interview occurred
in a nonprivate location such as the unit desk, a
lobby, or standing in the hall. This lack of privacy,
seen as a deterrent for the applicant,was highly dis-
tracting. Also, when the recruiter allowed inter-
ruptions, it was viewed negatively by the appli-
cants.
• She answered five pages and three telephone
calls.
• Although the supervisor was immediately re-
sponsive to my request to speak to a staff
nurse, she failed to provide us with privacy for
a candid conversation.
• Someone stuck their head in the door and the
manager immediately started talking to her
about the weekend. I felt awkward. She didn’t
even introduce me.
Travel Expenses
None of the organizations paid any travel expenses
of the applicants.This included mileage.
Recruiter Characteristics
Table 3 summarizes the most important characteris-
tics of recruiters as identified by the applicants, the
frequency of occurrence, and sample comments
made by the applicants in their narratives. As can
readily be seen, the recruiters ranged markedly in
terms of their approach. Many of the recruiters ei-
ther lacked the skills to be effective or were not per-
forming at their level of competency during the in-
terview.
474 JONA • Vol. 33, No. 9 • September 2003
Table 3. Priority Recruiter Characteristics
Factor N (%) Comments by Applicants
Informed/prepared 72 (59) She called me by the wrong first name, did not have my resume, and asked
extensive questions about my previous experience, which was spelled out on my
resume.
The person in human resources didn’t know about nursing and couldn’t answer
most of my questions.
Friendly/personable 71 (58) I felt like she wasn’t interested in me at all. She never smiled and was curt.
The nurse manager was off-standish, only speaking to the nurse coordinator.
Although she saw me, she did not acknowledge me until 2 or 3 min later. Even
during the interview, she was not friendly toward me.
Once her part of the process was complete, she asked if _____ was ready to “look
the candidate over.” I immediately felt like a warm body.
The staff said nothing to me.They just stared at me.
The clinical manager of the unit where I would work was outwardly hostile and
unfriendly for no apparent reason. Her reaction was enough to make me decide
against employment here!
The vice president for nursing failed to introduce me to anyone during the tour,
often leaving me awkwardly out of the conversation.
Approachable 70 (57) I was at ease with her. She was easy to talk with.
I met with 5 staff nurses, 4 of whom refused to even speak to me.The other one
was negative about management.
Smiled 69 (57) She smiled a lot.
Honest 62 (51) She didn’t tell me about the recruitment bonus. I spotted it on a newspaper on
her desk.
She did not tell me the pay for the job and the wage scale. This made me
suspicious.
She was not telling the whole story.
The staff nurse was straightforward.
I liked the manager. She was frank and realistic. She told both sides of the story.
I felt that the recruiter did not tell me as much as I wanted to know. It made me
cautious.
Positive/negative 62 (51) The head nurse was described by the director of nursing as a drill sergeant.
The staff member spoke positively about the manager but then said she’s
never there.
The nurse manager’s body language and tone of voice reflected exasperation with
some staff members.
She spoke disparagingly about the competitors, which made me wonder.
Attentive 56 (46) She did paperwork during the entire interview.
There were 5 pages and 3 telephones during the 30-min interview.
The coordinator left during the interview with no explanation and did not return
for 10 or 15 min.
The recruiter was rushed and took on a “glazed” look.
She even fell asleep!
The manager took numerous calls during the interview. She let people walking
down the hall stick their heads in to discuss last weekend’s date.
Listened 53 (43) She was pleasant, but she did most of the talking.
The manager gave thorough explanations, which made it obvious that they had
truly listened to my questions.
She went on and on in way more detail than I was interested in.
Eye contact 45 (37) The manager looked me right in the eyes. I liked that—she seemed interested
in me.
She didn’t look me in the eye once during the whole interview.
Helpful; facilitative 44 (36) Instead of explaining the clinical ladder to me, she gave me a 700-page procedure
book and told me to look it up. In my response to my question about commit-
tees, she gave me another large manual to look up.
She took care to see that I was escorted throughout the interview and tour.
Flexibility 35 (29) I was told I was being interviewed for an evening position in the intermediate
care unit.There was no consideration of what I wanted.
Used customized 21 (17) She was rote. She gave a canned speech.
approach I was simply told what position I was interviewing for, with no apparent
consideration of my needs or desires.
The manager couldn’t remember my name when she introduced me to the staff
nurse.
JONA • Vol. 33, No. 9 • September 2003 475
Postinterview Follow-up
One of the more interesting findings was that some
applicants felt there was a lack of appropriate clo-
sure to the interview. Problems occurred in a few
cases (“The manager directed me back to HR and
the recruiter was not available”). More important,
however, some potential employers (21%) failed to
ask applicants if they were interested in accepting the
position offered to them.A few (4%) did not actually
offer the position but apparently thought they did
(“They didn’t offer me the job but they called up sev-
eral days later and wondered if I was going to take
it!”). Sales theory would explain this on the basis that
the recruiter was fearful of being turned down and
thus did not ask “Will you take this position?”
It was shocking that there was no follow-up from 91%
of the organizations.That is, in only 9% of the cases did
the hospital follow-up with a phone call, letter, or e-mail
asking applicants if they had any questions or if they
thought they would take the position or encouraging
them to do so.
In terms of follow-up after the applicant turned
down the position, this next comment stands alone
in the data set as the only such example:
They checked my references and I received three fol-
low-up phone calls 8, 12, and 14 days after the inter-
view. Once I refused the position, I received a very
warm letter inviting me to consider this hospital in the
future.
Of the 9% that did follow through, the individual
who called the applicant was perceived to be too
pushy in 3% of the situations:
• This is the last chance you have to take this
job.
• You will probably regret not taking this posi-
tion. It is right for you.
Job Choice Decisions
The job choice process is a series of decisions made
by an applicant regarding which jobs and organiza-
tions to pursue for possible employment.We know
little about how applicants perceive and react to re-
cruitment and selection procedures and how those
perceptions and reactions influence attitudes to-
ward the organization.The applicants’ narratives re-
veal that impressions about the organization and the
job they were applying for began at the beginning of
the recruitment process. Despite this, it was clear
that the job choice decisions were ultimately made
on the basis of limited contact with potential em-
ployers and on incomplete information about the
jobs and organizational characteristics.
Applicants typically have little opportunity to
examine organizations accurately and assess their fit
with the job and hospital. Also, nurses applying for
staff positions rarely receive a second interview; job
offers are often made at the end of the interview.
This occurred despite the fact that the applicants in
this study were directed to collect comprehensive
information on the practice of nursing, the style of
management,and other factors that a “real”applicant
would be less likely to pursue.
“Positive Valence” Recruiters
The applicants in this study relied extensively on pe-
ripheral information such as the behavior of those
with whom they interacted in the hospital. They
were much more likely to select a given job if the re-
cruiters had a cluster of characteristics labeled for
the purpose of this study (“positive valence”). Posi-
tive valence recruiters had at least eight of the fol-
lowing behaviors (Table 3): friendly, personable;
approachable; smiled; direct eye contact; attentive;
listened;helpful,facilitative;informed,prepared;hon-
est; positive; customized approach; flexible. These
behaviors were more important than the features of
the job and the conditions of the work. If, however,
all of the interviewers in the four (or five) facilities
in the market area had positive valences, other fac-
tors became important in differentiating among fa-
cilities. Amazingly, this occurred only seven (6%)
times.
The impact of positive valence was summative.
If everyone with whom the applicant interacted
was high on positive valence, the applicants were
much more inclined to select that organization.
However, if one person was high and the other low,
this subtracted from the overall effect and de-
creased the likelihood that the organization would
be selected as a place of employment. If everyone
was low, the applicant did not choose the organiza-
tion regardless of other factors in existence, includ-
ing the highest pay in the grouping. If only one of
the interviewers was low, depending on experi-
ences with the other choices in the market area,
there was still a possibility that the applicant would
choose that facility. This also depended on which
“recruiter” was low—the reception desk clerk ver-
sus the unit manager.
Staff nurses carried more weight than managers
or recruiters because they were viewed as a more
credible source of information. Managers were con-
sidered more important than recruiters because
476 JONA • Vol. 33, No. 9 • September 2003
the applicant anticipated working with them. Yet,
because the recruiter was the first contact (making
that important first impression), it is possible that
they had a very strong but less evident impact on the
applicant’s judgments.This impact may have resulted
in the applicants’ prejudging their experience overly
negative (in low positive valence situations) or overly
positive (in high positive valence situations).
Another reason applicants gave so much weight
to recruiter/manager/staff behavior is that it symbol-
ized how people treat one another in the organiza-
tion. These individuals were considered to be reli-
able indicators of what it would be like to work
there. Based on observed behaviors of hospital per-
sonnel, applicants generalized making comments
such as “everyone is friendly here” and “this is a
warm place.”
After the recruiter positive valence element,
which clearly had the strongest influence on job
choice decisions in this study, the following factors
influenced the candidates’ decisions about which
position to select: (1) compensation; (2) working
conditions/practice environment; (3) form and sub-
stance of feedback given to applicant; (4) overall
hospital image and recruitment image of the organi-
zation; (5) the quality and amount information re-
ceived about the job and the organization; and (6)
the participation applicants were afforded in deter-
mining recruitment procedures.
Compensation
The applicants recorded the hourly pay level offered
to them by each organization.The spread tended to
be narrow within each market. However, if the qual-
ity of the interview and working environment were
relatively equal, the applicants tended to choose the
hospital offering the highest pay level as their em-
ployment choice. However, organizations that per-
formed poorly in the recruitment process were not
selected.Similarly,if the applicant perceived problems
in the working environment,the organization was not
chosen even if the pay level was the highest.
In one instance, an applicant experienced sev-
eral problems in the recruitment process at one fa-
cility (no response to the initial letter, not available
for the scheduled interview, and a hostile secretary
who refused to be helpful). In her narrative, she
stated that she would not take a position at this hos-
pital because of the “terrible way she was treated”
and “anyway, they had the lowest pay.” In reality, they
had offered her the highest hourly rate in the group-
ing of four facilities, but her overall impressions
clouded her perceptions of compensation rates.
Working Conditions/Practice Environment
Working conditions and the practice environment
had a definite impact on choice of organization,but
common themes did not emerge. Each applicant
had different priorities. For example, an applicant
did not want to work rotating shifts so this became
more important than staffing mix or participation
in decision making. However, nurse-to-nurse and
nurse-to-physician relationships stood out as criti-
cal elements in job choice decisions.Any evidence
of poor teamwork could “turn an applicant off”
while good working relationships were perceived
as an important positive factor. When the assess-
ment of teamwork fell in the average, typical range,
it receded as a factor of influence.
Feedback to Applicants
The form and substance of feedback given to the
applicants was another important element in the
recruitment process. Candidates who expected to
receive a job offer were more likely to feel positive
about working at the organization. Applicants
made assumptions about being offered the job
based on the behaviors of individuals in the orga-
nization.
Organization Recruitment and Image
The overall image of high-profile hospitals and its im-
pact on the applicant had an initial positive effect.
However, hospitals without high-profile images did
compete successfully. This occurred in the initial
stages where candidates decided who they would
interview if in a real-life situation, as well as in the in-
terviewing stage of the application process. In the
preinterview stage, effective recruitment materials
as well as timely and positive responses to inquiries
resulted in candidates selecting them for an inter-
view. In the interview stage, the lower profile orga-
nizations also competed successfully on the basis of
effective recruitment processes.
The recruitment image of the organization was
shaped largely by advertisements for positions,
brochures, and other written materials as well as the
impact of their displays at job fairs and other re-
cruitment events. An assessment of advertisements
and recruitment events was outside the scope of this
study. Although recruitment materials influenced ap-
plicants’ intentions to apply to the organization, it
was difficult for applicants to be specific about indi-
vidual characteristics of the written materials that
were appealing.They noted the “professionalism” of
the presentation, the appeal of the message, and the
attractiveness of the statements about the organiza-
JONA • Vol. 33, No. 9 • September 2003 477
tion. Applicants also reacted positively to longer re-
cruitment messages.
Quality and Amount of Information
The quality and amount of information received
about the job and the organization influenced job
choice decisions.There were several points in the
process where information was or could have been
provided. The quality and quantity of information
was critical as was the method by which it was
conveyed. When the organization was not chosen
for employment due to inadequate information, it
was because there was too little information or in-
formation was not viewed as reliable (ie, hand-writ-
ten brochures, recruiters who were perceived to
not be straightforward in their responses, discrep-
ancies by various individuals in the organization,
and no [or incomplete] answers to the applicant’s
questions).There were also instances where the ap-
plicant felt that there was too much information
conveyed or that rote, canned speeches were being
given.
Different applicants wanted different types and
amount of information. In most instances, recruiters
did not demonstrate skill in “assessing” applicants’
needs and wants in order to customize their ap-
proach. When recruiters were skillful, this was a
strong factor in the job choice selection of the ap-
plicant.The vast majority of the recruiters lacked an
understanding of sales theory and application so
they could determine needs and wants of each can-
didate and build their presentation of the job upon
features, advantages, and benefits of working at their
facility.
Candidate Participation
The amount of participation or control applicants
had in the development of the recruitment proce-
dure was an important factor in ultimate job selec-
tion. Applicants given some choice in the way they
interviewed (ie, who they interviewed with, when
the interview was scheduled, and which units they
would interview on) were more positive about the
organization than those who had little input. Partic-
ularly damaging were recruiters who “forced” appli-
cants into applying in specific areas. Even if there
were no positions on the desired unit, the applicant
felt more in control and positively inclined toward
the hospital when it was discussed with the appli-
cant by the recruiter.
Conclusion
This study demonstrates a tremendous number of
problems in every phase of the recruitment process.
These problems are costly for organizations in terms
of the loss of potential nurses, the selection of the
wrong nurses for any given unit, and wasted time.
Fortunately, these processes can be fixed if organiza-
tions take the time and energy to systematically ad-
dress them. Because so many hospitals have these
problems, organizations that commit to recruitment
process improvement can emerge as a recruitment
leader in their market area.
