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Hospital Improves Hiring, Placement, and Retention of Nurses, Using PXT Select™ Assessments

Updated: Nov 3, 2022


This organization has been in the business of operating hospitals for well over a century and is a multi-billion-dollar healthcare operation. Spread over several western states, this client has over 100 clinics and several regional hospitals, including more than 15,000 workers and nearly 1,000 employed provider doctors.


This general hospital network operates in several Western states, often in cities with small populations; the study location faced significant challenges in hiring and retaining new nurses in the Oncology Department, which was their most difficult work environment. Compounding the retention challenge—a competing hospital is right across the street in this small city. Pirating each other's professional staff was a time-honored HR methodology in this setting!

The client had not used assessments in their hiring and selection processes. And before introducing the PXT Select™ assessment, 33% of new oncology hires in their RN (registered nurse) positions failed before their 6-month anniversary; a whopping 40% of new CNA (Certified Nursing Assistant) hires failed before that point! The hospital's calculations placed the cost of each failed hire at over $80,000, so the financial consequences were a significant driver of an initiative to stop the bleeding.


In a serious modification of their hiring process, each new candidate for a nursing job in the Oncology Department was required to complete the PXT Select™ assessment as part of the application process. Contrary to their earlier fears that candidates would refuse to complete the assessment, they discovered that only 7% dropped out at the assessment stage.

Performance Models were created by assessing RNs and CNAs (separate groups, separate models) who worked in Oncology for two years or more; and scored in the top 25% on their annual performance evaluations. Candidates for hire who were scheduled

Interviews (based on their existing process) were scored on the assessment. The Comprehensive Selection Report was used to help identify finalists and to guide their subsequent interviews. Considering all the information available, final hiring decisions were made by the same team who had always made those decisions…but included the data from the assessment and the enhanced interview process. Once hired, new nurses were paired with an experienced mentor for their first six months on the job. The pairings were random, made for scheduling convenience, with the underlying assumption that the match between mentor and new employee pairings was not critical.

On occasion, pairings were changed when things did not seem to work.

Under the new program, the pool of potential mentors also completed the assessment; the Manager-Employee report was then used to guide pairings in an attempt to maximize compatibility between mentor and new hire. Once paired, the mentors received the Coaching Report to help guide their efforts. Anecdotal statements were that this process seemed to head off potential conflicts before they arose and provided valuable insights to the mentors they would otherwise have been without. The staff charged with mentoring duties were optimistic about these additional tools.

Using the PXT Select assessment to guide hiring and onboarding processes, these combined changes were utilized, and data was collected over 30 months.


Compared with the 30 months before the intervention, early hire failure rates (defined as termination for any reason before six months of employment) were dramatically reduced:

  • For both RN and CNA positions, early hire failures were reduced by 50%.

  • Analysis after implementing PXT Select™ revealed the overall match to

  • Performance Model scores and average tenure showed a remarkable correlation of 0.60.*

  • For the RN group, nurses with a match of 80% or above in their PXT results were all still on the job at the two-year mark!

  • For the CNA group, 75% of those with 80%or better match patterns in their PXT results were still on the job after two years.

  • For both groups, two-year retention more than doubled!

*Correlation is a statistical measure that expresses how two variables are related. It can range from -1 to 1. Values close to 0 indicate a low relation, and values closer to 1 indicate a strong positive relation.


Assessment costs for this pilot project totaled $20,000; the hospital's cost-saving calculation (via avoiding failed hires) was $350,000, for a return of $17.50 for every dollar invested.

This program focused on the Oncology Department—the operating unit with the most severe early hire failure challenge at a single hospital location. Eventually, given the success, implementing assessments expanded to three hospitals in the same setting.

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