Very few NHS organisations test potential nurse recruits on their aptitude for nursing, despite early evidence from trusts where it has been implemented that it can improve standards, analysis by Nursing Times reveals.
Last month’s critical report from the Health Service Ombudsman and the ongoing public inquiry into Mid Staffordshire Foundation Trust have once again highlighted the question of whether patients are being cared for in an appropriate and compassionate way. A Nursing Times survey also found concerns on the issue within the profession.
Some people perform really well at these tests because they know the right answers – in the same way that some children do better at exams
The final report of the Prime Minister’s Commission on the Future of Nursing and Midwifery, published last year, also highlighted that “excellent recruitment and selection processes will attract people with the right aptitudes, values and potential”.
However, an investigation by Nursing Times found that none of the 23 acute trusts that replied to a request for information on their recruitment process actively used any form of aptitude test to assess whether applicants for nursing jobs were compassionate or caring.
While some said they used extra assessments on top of traditional interviews, these were of technical skills and basic numeracy and literacy, rather than of attitude and behaviour. Some used psychometric testing for senior nursing posts, as a part of assessing their management skills.
The largest trust in the country, Imperial College Healthcare NHS trust, had previously considered using tests for assessing applicants’ levels of compassion but has yet to implement the idea. A spokeswoman said it had not ruled out the move.
Nursing Times found the idea was more likely to be used in the mental health sector, where three out of 14 trusts that replied said they had some form of assessing nurse aptitude – such as psychometric testing, group exercises and the involvement of service users – and a further two were thinking about introducing it.
A spokesman from Leeds Partnerships NHS Foundation Trust said psychometric tests were available for recruiters to use if they wanted during interviews – including ones for “emotional Intelligence” and “occupational personality”.
He said: “These are available to all trust staff and are used at the discretion of appointing officers. They are included in our current recruitment and selection procedure, which was approved on 1 October 2010.”
The South London and Maudsley NHS Foundation Trust introduced a multi-phased test – known as an “assessment centre” – for band 5s in 2006, which involves group discussion exercises that assess attitude and behaviour, as well as technical skills.
Roddy Wells, recruitment services manager at the trust, said: “We have apocryphal evidence that we’re getting more appropriate people.”
Peter Walsh, assistant director of nursing at the Central and North West London NHS Foundation Trust, which introduced a similar process in 2009, said: “What we have heard from staff, who have been around for a few years, is that they’ve noticed a difference in the quality.”
He noted that around 100 nurses had so far been recruited using an “assessment centre” out of a workforce of around 1,400. Mr Walsh said: “It’s early days, but what we’re hearing from senior staff is very positive, [they have] noticed a difference.”
He added: “The number of staff that we have to performance manage has started to drop, so that’s an early indicator [of better quality].”
The Welsh Assembly has gone a step further and since last year required that all applicants to pre-registration nursing courses are assessed on their caring disposition (see box 1 below).
Spokespersons for the Scottish Government and the Department of Health in England, however, said they had no plans to follow Wales’ lead.
Despite the changes in Wales and early indicators of success from assessing aptitude in mental health nursing, many in nursing remain to be convinced of its worth.
Peter Griffiths, professor of health services research at the University of Southampton, said: “Clearly it’s an attempt to answer a real problem but anyone who is recruiting student nurses or recruiting nurses is in part selecting for aptitude, however they do it.
“I think the history of aptitude testing in a lot of different fields is quite a long one but I don’t think there is compelling evidence that it is particularly successful and certainly it isn’t a panacea to the problem.”
Unison head of nursing Gail Adams said she would have concerns if psychometric testing, in particular, was used more widely in nurse recruitment.
“Psychometric testing is a useful tool for some roles but it can only be used as part of the process,” she said. “Some people perform really well at these tests because they know the right answers – in the same way that some children do better at exams.”
Ms Adams said: “The simplest solution is to make sure organisations have safe and effective recruitment procedures in place, that those processes are asking the right questions and testing someone on the evidence in their application.
“For example, if a nurse is applying for a job in care of the elderly then why do they say they have no interest in orthopaedics, which is such a big part of elderly care?”
Linda Nazarko, nurse consultant at NHS Ealing, said the idea doing a psychometric test would personally “terrify” her.
“If there were two jobs and one asked for a psychometric test, then I would apply for the one that didn’t have the psychometric test,” she said. “We have got to be very careful not to put young people off nursing. If we’re seen as more selective than any other profession they might not choose to apply for nursing.”
But Paul Hodgkin, ex-GP and founder of the Patient Opinion website, said: “Evidence from the HR field show that when people are recruiting it is really important to recruit for attitude, so anything that improves the selection of nurses and students have the right attitude is really important.”
He added: “I don’t know how useful aptitude testing in the form of psychometric tests are, but I can imagine that it might be.”
|Box 1: Colleges screen for caring types|
The first batches of nursing students in Wales underwent screening for their suitability to enter the “caring professions” in the autumn, as part of a Welsh Assembly initiative.
Under the scheme, all applicants for pre-registration nursing and midwifery courses are required to provide a character reference, and guidance for interviewers asks them to ask specific questions on caring.
The statement must be from a person who has been in a position to observe the attitude and behaviour of the applicant, or if the applicant has already worked in the healthcare sector, the statement must be signed off by a relevant health professional.
The statement includes rating applicants from one to seven on how they meet nine standards, including whether they show “a caring disposition towards others” and “are always polite”.
During face to face selection interviews, the interviewers are required to specifically question and look for evidence on how well the applicant “understands” what is meant by care/caring”.
Chief nursing officer for Wales Jean White told Nursing Times the initiative, which was piloted in summer 2009, had now been rolled out across Wales and was used for the recruitment round for all students starting in the 2010-11 academic year.
She said the changes had been implemented to “address the concerns being voiced about ensuring a robust selection process that identified the most suitable candidates to enter these caring professions”.
Nursing Times understands a small number of higher education institutions in England also carry out their own aptitude assessments when selecting applicants for pre-registration nursing courses.
Cath Gorman, associate director of nursing – quality and compliance at Ipswich Hospital NHS Trust, said all shortlisted applicants at University Campus Suffolk are required to attend a recruitment day.
She said part of this involved group work where applicants were given a topic to discuss. “The topics are health related and contentious with aspects of ethical dilemmas, equality and diversity – the groups are asked to present an opinion of pros and cons. They are observed throughout for their interpersonal skills,” she said.
|Box 2: Training tackles attitude and behaviour in A&E|
Accident and emergency nurses at Medway NHS Foundation Trust have recently been given training on “attitude and behaviour”, after a patient experience survey highlighted problems.
Board papers published by the trust in December said a monthly report on patient experience had identified themes including the attitude of nursing and medical staff in A&E.
As a result, the board was told that “nursing staff are currently undertaking development training that includes attitude and behaviour styles”.
A spokeswoman for the trust said: “The training consisted of a DVD set in a healthcare environment. It gave examples of poor attitude followed by examples of best practice.
She added: “The training has helped raise awareness amongst staff and we’re now looking at how we can build on this with further customer care training.”
She also confirmed that the trust does not aptitude testing as part of its nursing recruitment process.
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Should nurses be tested on their aptitude for nursing and caring when applying for posts?