Recruiting and Retaining an International Health Care Workforce

Fisher-Titus Medical Center | Norwalk, Ohio

The Background

Fisher-Titus Medical Center is an independent, 99-bed rural community health system in Norwalk, Ohio. The health system encompasses a Level 3 trauma center, Level 2 cardiac catheterization lab, and achieved primary stroke certification through the Accreditation Commission for Health Care, while also being home to a 69-bed skilled nursing facility, 40-unit assisted living facility, and home health center. Fisher-Titus also employs an ambulatory physician group that provides primary and specialty care across 18 different sites. There are a number of outpatient ancillary services, including lab, imaging and radiology as well as robust adult and pediatric rehabilitation services. With such a wide range of care services being offered, maintaining a robust and qualified health care workforce is of the most importance for Fisher-Titus leadership, even before the trials of the pandemic.

International Nurse Recruitment

After the nursing shortage evaluation was completed in 2018-2019, Fisher Titus identified PRS Global as a partner and began international recruitment. Because Fisher-Titus wanted to ensure that the new nurses felt part of the staff and the greater rural community, they chose the direct hire option as opposed to the contract staff approach. Fisher-Titus also recognized that it was crucial to ensure the current nurses understood that this was not a replacement plan, but rather a sustainability plan of which the current nursing team played an important role.

Leadership initially thought it would take a minimum of a year for the new nurses to arrive, but with complications that arose from the pandemic, both public health and immigration delays, that process extended to 18 months at times. Fisher-Titus knew it was critical to find the right individuals and the right onboarding structure, so they developed a comprehensive interview process with front-line leaders, front-line staff and a final interview with the chief nursing officer. Nursing candidates were chosen by skill and fit, and Fisher-Titus onboarded them with a shared support system they built to ensure mutual success. This system included a community mentor program, peer mentor preceptor program, general onboarding, culture and diversity classes for existing staff, as well as new team-building events for when the candidates arrived.

Lessons Learned and Future Outlook

It was critical to stay connected with the international nurses from the time they are hired through the date of arrival, which as mentioned earlier could take as long as 18 months. Once there was an arrival date for those nurses, the next step was to work with human resources to ensure a seamless onboarding process. It was only one week from the date the nurse arrives to the date they began their employment. Fisher-Titus worked to complete as much of the pre-hire paperwork and preparation they could do in advance of arrival given this short timeframe. These individuals are leaving everything they knew, and helping them understand what to expect when they arrive is very important for a successful transition. They also worked closely with the community mentors and greater Norwalk community in order to obtain affordable rental housing for the new nurses and their families.

Another challenge were the minor differences in general nursing practice between cultures. Although the hiring staff had discussions with the new international nurses, as did their partners with PRS Global, some of those differences were not identified until the nurses arrived. Fisher-Titus thus relied heavily on the preceptors and the clinical education team to address those differences as the nurses joined the nursing staff. Since the first nurse arrived, the education programs have grown, and staff incorporated the challenges into the international nurses’ monthly education so at the end of orientation they are a successful member of the Fisher-Titus nursing team.

One of the biggest challenges was getting clinical leaders comfortable with the fact that they were identifying individuals who would join the team 12-18 months from when the process began. Generally, hospitals recruit for a position that is open today and a skill set to meet that need. It was necessary to shift that mindset to one that clinical leaders are identifying the skill set needed for the team and the individual that fills that skill set, but they are not necessarily identifying someone for that specific position.

Ultimately, Fisher-Titus has incorporated the comprehensive programming to support the nurses joining the workforce, the nurses supporting them and the community members who stepped forward in order to sustain the program and ensure the new nurses feel like a part of the Norwalk community. They sign a three-year commitment, and the goal is that the environment that they collectively build encourages the international nurses and their families to remain at Fisher-Titus and in Norwalk for many years to come.

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Building a robust nursing workforce is hugely important in providing quality care to patients, but poses unique challenges in rural Ohio. In this conversation, Fisher-Titus’s Stacy Daniel, director of clinical programs, and Katie Chieda, chief nursing officer, share how their team concentrated on recruiting international nurses to ensure that they remained a strong, independent health system for years to come.

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