A new procedure in the evaluation of nursing aide applicants. (Health Care Providers Inventory test)

Much of the day-to-day care in long-term-care facilities is provided by nursing aides. And to a great extent the quality of care is related to the quality of the people who are employed in those positions. In many settings, the turnover rate for such employees approaches the astronomical. National figures have been estimated to range from 45 to 100 percent. In 1985, the average nursing facility in Illinois had a turnover rate of 72 percent, with some recording turnovers as high as 400 percent. Annual turnover rates greater than 100 percent are common. The quality of care and the efforts to contain costs are severely hampered by such heavy turnover. Adequate programming cannot be implemented when the staff charged with such implementation are going through a revolving door.

The assessment of new staff is becoming increasingly more difficult, as facilities are reluctant to share information regarding previous employment, fearing law suits if a negative report is given. Typically, dates of employment are the only pieces of data that will be released. Employment decisions usually are based on interviews, employment history, and education. Those factors are important, but may not be sufficient to secure the better-qualified applicants and to reduce the expense of high turnover.

Another very important reason for good selection procedures, which is beginning to receive more attention, has to do with the liability incurred by the regrettable behavior of employees. Health-care facilities spend vast sums of money each year to insure themselves against such occurrences, some of which can be truly devastating to residents, staff, and the reputation of the facility. The financial losses, though quite severe at times, are covered by the insurance carrier. The loss of reputation in the community, and resulting loss of referrals and future income, can require long periods of time and great efforts to recoup. Negligent hiring practices can lead to a more permanent and debilitating consequence to the facility, and to its investors, through the loss of the operating license. That is a catastrophic consequence of negligent employee actions. Liability insurance cannot protect investors from such an event.

Turnover has been attributed to many factors including: local and national economic conditions, working conditions and management style, and the individual characteristics of the employee. Although the state of the economy is not under the control of management, the second two factors can be addressed. A great deal has been written on the various approaches to long-term facility management and programming. That information is widely available, and much can be derived from the implementation of basic principles. With regard to employee assessment, a need exists in the long-term-care industry to be able to evaluate applicants quickly and to identify the presence or absence of the various characteristics related to quality of care and retention.

What can be done to evaluate nursing aides more adequately? A new preemployment instrument now is on the market for such evaluations. It is the "Health Care Providers Inventory" (HCPI), a paper-and-pencil test.' It is available in booklet form, which is scored on-site. The scores are then called in to the testing service where a report is prepared and mailed the same day to the nursing facility. The HCPI also is available in a computerized version; the test is computer-administered and computer-scored.

The HCPI is validated on nursing aides whose job performances were evaluated by nursing supervisors; research evidence shows that it is nondiscriminatory on the basis of sex and race. HCPI is a 70-item questionnaire with five primary scales. The scales measure:

The ability to relate to nursing home residents; The ability to communicate clearly and courteously;