Frances Matthews, the director of clinical services at Appalachian Home Health Services, Inc. (AHHS), was concerned. AHHS needed to hire a nurse quickly. One of the staff nurses had just han

Please read the case study bellow, and answer the questions:
1. What is the introduction of the case study bellow?
2. What is the major steps and decisions involved in recruitment and selection of the case bellow?
Appalachian Home Health Services
Kathryn H. Dansky
Pennsylvania State University, University Park, PA
Frances Matthews, the director of clinical services at Appalachian Home Health Services, Inc. (AHHS), was concerned. AHHS needed to hire a nurse quickly. One of the staff nurses had just handed in her resignation because her husband was being transferred out of state. The nurse who was leaving gave AHHS 2 weeks’ notice, which complied with the agency policy; however, it still left the agency in a bind. Matthews knew that recruiting and interviewing home health nurses was a time-consuming process, and, even after a nurse was hired, several weeks of orientation were usually required before the nurse could perform independently. She knew that all of the regular staff nurses were working to capacity and that the loss of even one nurse would have major implications. She walked over to Kate Hennessey’s office to discuss the situation. Hennessey was the director of administrative services. Matthews and Hennessey had started AHHS 4 years ago. Together, they made all final hiring decisions.
Matthews knocked on the door, saw that Hennessey was sitting at her desk, and walked in. “Sue is leaving. She sure picked a bad time to move!” She laughed halfheartedly, and said, “We need to replace her quickly. Do you have any brilliant ideas?”
Hennessey sighed, and responded, more in the form of a statement than a question, “We don’t have any decent applications on file, do we?”
“Nope.”
“Great. Well, there’s an online RN recruitment site that has been getting good publicity. It’s https://www.healthcareers.com/. I’ll post something there. Let’s also get our ad into the newspaper’s online section. Maybe something will turn up.”
BACKGROUND
AHHS is a private, not-for-profit home health agency, located in a rural area of a southeastern state. The stated purpose of AHHS is to provide health care services at home to elderly individuals, persons with disabilities, and persons with short-term, specific health care needs that could be handled at home.
AHHS is a “fee-for-service” health care organization; it provides in-home services, then bills for the services, either to a public or private insurance carrier (e.g., Medicare, Medicaid, Blue Cross/Blue Shield), or to the patient directly. AHHS receives all (100%) of its revenue from billed services. As a private organization, it does not receive government subsidies or tax support.
Competition in the home health field is intense, particularly in rural areas, where the need for services fluctuates. Because services are expensive to provide, it is critical for agencies to generate a volume of visits sufficient to cover fixed expenses plus make a small profit. Competition for AHHS comes primarily from Care One, Inc., a multicounty operation that has been established in the area for well over 10 years. AHHS surpassed Care One in total number of visits after its second year of operation and has been steadily growing. Many of the physicians in the area, however, continue to use Care One, and Care One receives more referrals from hospitals outside of its service area than does AHHS.
AHHS currently has 32 employees, including 15 registered nurses (full time and part time), 8 nursing aides, 2 physical therapists, 1 speech-language therapist, and 7 administrative staff. All but two employees at AHHS are female.
REFERRALS FOR SERVICE
Most of the business generated for AHHS is in the form of referrals. Hospitals (social workers, discharge planners) account for more than 70% of patient referrals; of this total, approximately 85% are from the two local hospitals and 15% are from out-of-town hospitals. The second most frequent source of referrals is the general public; former patients, potential patients, family members, clergy, and the like may request services directly. Approximately 20% of referrals come from this source. A small number of referrals come directly from physicians. Although this source is less than 10% of the total, it is important to AHHS, because of the power and status that physicians have in the community.
PATIENTS WHO RECEIVE HOME HEALTH SERVICES
Most of the individuals who receive in-home care are elderly. They usually have a chronic illness that requires monitoring or have a need for rehabilitation therapy following an acute episode, such as a stroke or hip fracture. Some patients have disabilities and require ongoing therapy at home. Some are convalescing from a hospital stay, and need short-term care (e.g., dressing changes). Others have a special type of acute medical need that does not require hospitalization, such as intravenous antibiotics or chemotherapy.
Most of the patients cared for by AHHS are indigenous to the area, live in rural areas, and are religious. Although not all patients fit this description, it is fairly safe to say that the patient population is elderly, traditional, and conservative.
THE ROLE OF THE HOME HEALTH NURSE
The registered nurse is the central caregiver in the home health field. Home health nurses must be able to function independently and comfortably in the patient’s home, and must be capable of performing a wide variety of clinical procedures (e.g., giving injections, inserting catheters, obtaining specimens). In rural areas, the nurse may be the only contact that the patient has with the local healthcare system. Therefore, the RN is considered to be both a “case manager” and a “gatekeeper” in coordinating medical, health, and social services (see Table 26.1). This position requires high-level skills in nursing and communications. Due to the incorporation of electronic medical records, as well as remote monitoring (telehealth) services, in the home health industry, computer literacy is also necessary. Nurses with a Bachelor of Science in Nursing (BSN) degree and experience in home health or community nursing are usually sought for these positions.
ANSWERS TO THE AHHS ADVERTISEMENTS
After Matthews left, Hennessey asked the office manager to send a copy of their standard classified ad for a home health nurse (see Figure 26.1) to the local newspaper’s office. She also submitted a similar ad to healthcare.com. The next day, the newspaper carried the ad in the classified section, both paper and online. The newspaper and healthcare.com ads ran for 3 consecutive days. Applicants were requested to call the office, or to send a résumé to the director of clinical services.
Table 26.1. Job description for home health agency registered nurse
DEFINITION
The registered nurse administers skilled nursing services to individuals in their homes, in accordance with a written plan of treatment established by the patient’s physician. The incumbent is directly responsible to the Nursing Supervisor and ultimately to the Director of Patient Services.
QUALIFICATIONS
Graduate of an approved school of professional nursing
Current license to practice as a registered nurse in this state
RESPONSIBILITIES
Conduct initial patient assessment and evaluation
Evaluate the ongoing needs of patients on a regular basis
Initiate the patient’s plan of treatment and any necessary revisions
Provide those services that require substantial specialized nursing skills
Initiate appropriate preventive and rehabilitative nursing procedures
write and maintain clinical notes, using the agency’s EMR system
Coordinate care with allied health professionals
Inform the physician and other personnel of changes in the patient’s condition
Counsel the patient and family in meeting nursing and related health needs
Participate in in-service and continuing education programs
Supervise and teach other nursing personnel
AHHS received two responses to the ads. (Both responses were from the newspaper online ad). One was a résumé from a student at a nearby technical college. The college had a 2-year (associate degree) registered nurse program, and the applicant was in the last quarter of her second year. She had no experience in the healthcare field but had been caring for her elderly father. After his death, she decided to return to school. Matthews knew, from past experience, that RNs from 2-year programs lacked many of the skills for this type of work. She decided not to interview this applicant.
The other applicant, Margaret Jenkins, called to express interest in this position; the conversation was pleasant and informal because the women knew each other. Jenkins had lived in the area all her life, had family there, and was well known for her community activities.
Jenkins is a registered nurse, with a BSN from the local university. She had most recently worked for 8 years for Dr. Edward Smith, a general practitioner in town. Prior to that time, she had worked at the state mental health center. Written references from both employers indicated that she was hard working, responsible and professional, and got along well with patients, staff, and physicians. Hennessy decided to call Dr. Smith’s office to gain additional insight. She spoke to the office manager, who spoke warmly and enthusiastically about Jenkins. The office manager added that Dr. Smith was cutting his hours because he was nearing retirement. Otherwise, they would have rehired Jenkins.
Eighteen months ago, Jenkins was involved in a domestic violence situation in her home. During an argument with her husband, according to the press, Jenkins was physically attacked, and the argument ended in the death of her husband. Jenkins was charged with murder. During the course of the trial, most of the details were made public. Episodes of violence had occurred previously, resulting in a separation of Jenkins and her husband, with a restraining order against the husband. Jenkins testified that on the night of the fatal argument, she was home with her two young children when he appeared and threatened all three of them. While her husband was beating her, she managed to pick up a large kitchen knife and stab him. The court convicted her of involuntary manslaughter and sentenced her to 10 years in prison. While she was in prison, her attorney petitioned for early release, based on her standing in the community and the fact that she was the sole support of two young children. Also during this time, several concerned friends led a successful campaign to have her nursing license reinstated. (The state board of nursing had revoked her license to practice nursing, a standard practice for convicted felons.)
Jenkins’ immediate concern was finding employment, since Dr. Smith, her former employer, was not able to rehire her. When she saw the AHHS ad on the newspaper site, she thought it was her answer. Now that she had her license back, she could begin working immediately. But her criminal record weighed heavily on her mind.
THE INTERVIEWS
After initial review of applications by the nursing supervisor, the procedure at AHHS was for all qualified applicants to be interviewed first by the nursing supervisor, then by the two directors, Matthews and Hennessey. Because of Jenkins’ good work record and because no other suitable applicants were available, Matthews asked Jenkins to come in for an interview, and set up an appointment for that afternoon.
Jenkins walked into the AHHS offices and greeted everyone warmly. A Caucasian woman of average height and weight, she appeared to be in her mid-thirties. She was on time, was dressed appropriately, and looked nervous. Barbara Jones, the nursing supervisor, introduced herself and led Jenkins into the conference room. A half-hour later, Jones brought Jenkins to Hennessey’s office, where the second interview would take place. Jones went in first and briefly summarized her interview. Although she had a positive overall impression, she was concerned about Jenkins’ lack of experience with home health procedures, particularly interviewing and assessment skills. Because this part of the job was so important to the overall plan of care, it was essential that RNs have experience in this area. She then left the office and Jenkins went in.
Jenkins sat down with Hennessey and Matthews. The three women discussed AHHS policies and general personnel issues, including benefits. It was clear that Jenkins had the abilities needed, she knew the geographical area well, and could communicate effectively with area physicians. Her only weakness was that she did not have home health experience. Her personal life was not discussed, but she did remark at one point, “You know, I really need this job.” At the end of the interview, Matthews thanked her for coming, and said, “You do meet many of the qualifications, but I’m not sure if you’re the right person for this job.” Jenkins smiled grimly and said, “I wouldn’t blame you if you don’t want to hire me.” With that, she picked up her things and walked quietly from the office.
Matthews and Hennessey looked at each other. “I don’t know,” Hennessey said. “I don’t know either!” responded Matthews. They usually based their hiring decisions on qualifications plus “intuition,” and usually agreed on an applicant’s suitability. This case was different, however, and neither was sure whether they should hire Margaret Jenkins. Matthews said, “Well, let me know what you decide,” and left the office.
Hennessy reviewed the application, references, and notes from the interview. In addition to her lack of home health experience, Jenkins had never had the opportunity to utilize clinical assessment skills, such as auscultation and physical examination. She used a personal computer, but had no experience with electronic medical records.
More importantly, Hennessy wondered about the ramifications of hiring or not hiring a convicted felon. Was discrimination a potential issue? She also felt that some of their elderly patients, who held more traditional views about women’s roles, might react negatively to having Ms. Jenkins in their home.
Hennessy searched online to find laws related to discrimination against convicted felons. On https://www.eeoc.gov/laws/practices/she learned that federal law addresses this question in Title VII (basic employment discrimination law). Specifically, an employer can refuse to hire if the felony conviction directly affects a felon’s qualifications. Her search for state laws found http://lac.org/toolkits/standards/Fourteen_State_Laws.pdf.
Kentucky law forbids discrimination by public employers and licensing agencies. However, public employers can consider applicants’ convictions if they relate directly to the employment. The statute does not protect persons convicted of “felonies, high misdemeanors, and misdemeanors for which a jail sentence may be imposed,” as well as crimes of “moral turpitude.” A quick call to their attorney confirmed that AHHS could claim “job relatedness” if they decided not to hire Jenkins.
Hennessy considered her options. She knew she had to make a decision soon.
ENDNOTE
This case used by permission of the author. From Dansky, K. H. (1991). Appalachian Home Health Services. In G. E. Stevens (Ed.), Cases and exercises in human resource management (5th ed., pp. 246-251). Homewood, IL: Richard D. Irwin, Inc.
CASE STUDY DISCUSSION
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