Hiring nurses, “Survivor”-style

Jacaranda’s model for creating a chain of maternal-health clinics relies on staffing both our mobile clinics and our fixed maternities with skilled nurses and midwives. Our nurses will provide antenatal care, post-natal care, deliveries, and basic emergency obstetric care. For c-sections and emergencies requiring a theater, we will refer patients to partner organizations that are equipped to handle such cases – but we rely on well-trained nurses and midwives to handle the majority of mothers we see. Everyone in the maternal health community knows that we cannot rely on doctors to improve global maternal health; there simply are not enough of them.

Our first mobile clinic and fixed clinic are designed to serve as proof of concept, demonstrating that our model taps into a demand and is suitable for expansion throughout Nairobi, Kenya and east Africa. So it was important that nurses we hired for these first clinics be experienced and confident. We needed candidates for whom a brief, intensive training curriculum would be sufficient, and who would be able to help train future hires as Jacaranda grows.

At the same time, we were not merely looking for nurses who were technically skilled. Our research told us that one of the biggest sources of dissatisfaction with existing maternal-care options in Nairobi – and one of the biggest factors deterring expectant mothers from seeking medical care in Kenya – was unfriendly, disrespectful care from nurses. We needed nurses who would break that stereotype. Furthermore, we needed candidates who could handle the unpredictability of a mobile-clinic setting, and who would welcome the opportunity to receive feedback and learn new skills

So all we required was experienced, friendly, empathetic, resourceful nurses who showed grace under pressure, willingness to learn new things and an ability to work on a team. But how to evaluate for this kind of well-rounded supernurse?

To accomplish our goal, we needed an interview process that would let us evaluate candidates for each of our core criteria. With advice from experienced trainers Julius Maina and Dr. Marianne Darwinkel at Community Health Promotion Kenya, and the loan of some training equipment from Nairobi’s Kenyatta Medical Training College, we developed a framework that was part interview, part reality-TV challenge. Each of our 16 top candidates completed a timed, eight-station circuit of tests, designed to show us their skills across each of our key indicators. Some examples of the evaluations we devised to assess candidates’ skills:

Exam-room experience: At one station candidates performed digital and speculum exams on an anatomically correct obstetrical dummy, to assess cervical dilation and effacement. At another, our prospective nurses queried a sample patient on her medical and obstetrical history and recorded what they judged to be the relevant pieces of information. 

Mobile-phone proficiency: Our technology station called upon each candidate to send a text message formatted in a specific way, as well as complete a timed exercise entering patient data into a mobile-health application.

Empathy and people skills: Each nurse counseled a sample patient who was about to have an HIV test as part of her antenatal care appointment.

Resourcefulness and management: Candidates answered an essay question on how they would cope with a hypothetical emergency situation that arose at a very busy time in the mobile clinic, and another question on how they would identify key performance indicators, or KPIs, for Jacaranda to measure clinic quality and improvement over time.

We had a strong group: Most candidates performed very well on the hands-on stations. But we found when faced with an unexpected challenge, some nurses stayed smiling and upbeat, while others grew frustrated and impatient.

We weren’t just tormenting our candidates. Research shows that that an organization’s human-resources practices directly and substantially impact its health outcomes. We are committed to finding the HR strategies that will make us the most effective organization we can be – which, for us, means a focus on constant improvement in everything we do. We’ll target improvement in all the ways we can think of: incorporating customer, manager and peer feedback into our performance-review process, holding regular brainstorming sessions to generate ideas for improvement, and building professional-improvement time (akin to Google’s famous flex time) into our employees’ work schedules. All of which should result better care and happier, more productive staff, but only if we hire staff that are comfortable learning from their mistakes and constantly striving to improve.

Our gauntlet of tests produced a happy result: We hired three nurses with the mix of qualities we were looking for. Once they were on board and we were all in the van en route to the clinic, I asked them about their experience of the interview process. They laughed, and commiserated: “It was so difficult!” But they didn’t seem too traumatized. “Everyone was so friendly, so we didn’t feel harassed, even when we made mistakes,” Glory Kathoka told me. Cathy Kiboi contrasted the Jacaranda experience to typical job interviews: “Usually you are just standing in front of a panel and they are asking you questions and you are… defending your experience, but you don’t do anything with your hands. I think these practicals are necessary. Because otherwise, how will they really know your capabilities?”

Nurses

We are happy that they feel that way, because our nurses have the opportunity to take a primary role in Jacaranda’s growth – helping us work toward a future in which good maternal care ceases to be a luxury, and becomes a universally available human right.

 

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