Net Hires Shows The Difference Between Meeting Hiring Targets And Growing The Workforce

Hospitals recruit nurses and other employees all year, and many still can't fill their units. Burnout and labor shortages push people out almost as fast as new ones arrive. Employers in other industries report the same trouble finding qualified candidates, which Criteria tracks in its annual Hiring Benchmark Report. A hospital can hit its hiring goal and still end the year with about the same headcount it started with. Tracking net hires, the number of people hired minus the number who departed, shows leaders whether recruiting is growing the workforce or mostly replacing lost workers.

Corrian Nwankwo is Founder of CROWNE, an advisory firm that helps organizations with people strategy, leadership development, and workforce planning. Before launching the firm, she spent more than two decades running recruiting and HR for hospitals. She started as a nurse recruiting manager at CHRISTUS Health and went on to lead talent acquisition for the system's 16 hospitals across Texas and Louisiana. Most recently, she served as Interim Vice President of Human Resources at JPS Health Network, a Fort Worth health system with more than 7,000 employees. In those roles, she saw that hospitals rarely compared their hiring numbers with their turnover to see whether they were gaining ground.

"Hiring can look really good on paper. But you can't be productive if 80% of your hiring efforts are going to backfilling," Nwankwo says. Each replacement only returns a unit to where it was, and new nurses need months to work at full speed. Until they do, the experienced nurses around them pick up the slack.

Tracing the losses

The two numbers behind net hires usually belong to different teams. Recruiters report how many people they hired. A separate HR team tracks departures. Each team uses its own figure for its own work, so neither sees the combined result. "Net hires tells you just a little bit. It helps you identify where you might be having an issue," Nwankwo says. To find the cause, she breaks the number into its parts.

Some of the causes show up early in the hiring process. If candidates wait too long between applying, getting screened, and meeting the hiring manager, many take offers elsewhere. Offer acceptance rates show how often candidates turn jobs down, and asking why can reveal whether timing or pay is the issue.

Other causes appear after people start. First-year turnover is one of the most useful numbers to watch. In hospitals, more than one in five newly hired nurses leaves within a year. When that happens, the organization loses most of what it spent recruiting and training them.

People inside HR can often explain what the numbers show. Business partners who work with individual departments hear about struggling teams and managers who need support. The data becomes more useful when recruiting, talent management, and those business partners share what they're seeing, Nwankwo adds.

The right response depends on what turns up. In nursing, she has used leadership development and DISC training, a work-style assessment, to help new nurses understand how their teammates and managers operate so they settle in faster. Every department is different, she notes, so the solution has to fit the department.

Recruiting by specialty

Many of these exits trace back to decisions made before anyone is hired. A new nurse who didn't know what a unit would demand, or who joined a role that was never clearly defined, is more likely to leave in the first year. Nwankwo says recruiters can head off many of these departures. Before filling a role, they should check that the job description reflects the work the new hire will do each day.

She favors assigning each recruiter to a single specialty. "If you are a critical care or emergency department recruiter, that should be what you own. You know what the market is doing and where your competition is. You round on that unit to understand what's going on, so you can make the right hire and recognize when someone probably isn't going to make it in that department," she says.

Rounding means regularly visiting the unit, talking with managers and staff, and watching how the work gets done. Recruiters who do it learn how each leader manages and what kind of person tends to do well on the team. That knowledge helps them ask candidates more pointed questions and describe the job accurately, so the hospital and the candidate can both judge the fit before an offer goes out.

For nursing, that work can start while candidates are still in school. Hospitals can host events where nursing students meet hiring managers and tour the units where they might work. "I believe in them coming in and seeing exactly what an emergency room looks like and what a critical care area looks like, way ahead of time," Nwankwo says. Students who return to apply after graduation already know what working there looks like.

Past the honeymoon

Retention also depends on what new hires experience once they arrive. New hires spend roughly their first 90 days in a honeymoon period, when they're still forming an opinion of the job, and small details shape that opinion. Did their equipment arrive on time? Did their manager meet them on the first day? Did they feel welcome? "The sooner they integrate into the organization, the faster productivity moves up," Nwankwo says.

She recommends checking in with new hires between three and six months. In her past roles, employees who reached about six months on the job were invited to breakfast with the CEO, where leaders asked how they were adjusting. HR also tracked engagement at that point to catch problems before people decided to leave.

Nwankwo acknowledges that net hires doesn't tell the whole story. It does help leaders answer a basic question each year: does the organization have more people and a greater ability to do its work than it did 12 months earlier? In healthcare, where burnout already weighs on employees, the answer affects engagement and how well people can care for patients. "We spend a lot of time hiring people, onboarding them, and investing in talent. It's important for organizations to take a pulse on whether or not they grew," she says.