How to avoid the Nursing Work Culture From Hell

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Culture at the workplace?

A workplace becomes a surrogate family for the people who spend time there. When people spend so much time together, the personalities come out. A group will adopt a set of informal rules that guide each day. This becomes “workplace culture.”

If you have been a nurse for any length of time, you develop a sixth sense for this. The minute you walk on to the patient care area, you get a vibe of what it’s like there.  It may be calm and peaceful, it may be chaos, it can be happy or tense. It can be this way independently of how much nursing care the patients require. When you interview for a nursing job, be advised: the best managers know about workplace culture, and they are looking to add staff who will value it and honor it. A theme of this blog has been to encourage new nurses to live up to their caring potential, and it includes caring for those around them as well as for the patients.

Urban Community Hospital – a “war story”

My first nursing job was not a place for teamwork. It was an “urban community hospital”  and chronically understaffed. Each shift was a contest to see whether you could get through all the work yourself, and the assignment was heavy. It was a trauma ward, lots of gunshot wounds and stabbings and victims of beatings, along with a population of heroin addicts and homeless persons. Lots of crime victims. The staff consisted of a head nurse who had worked there since the dawn of time, and each spring there was a fresh crop of new graduate RNs. The hospital would hire a batch of new grads all at once, they would stay a year, then leave once they got “the golden year” of hospital experience. Or at least they were planning to leave then; most left my particular unit before hand, chewed up by the system of unsupportive coworkers. The crew of nurses aides were all older than the young RNs.

Walking Rounds

We did “walking rounds” there, change-of-shift report consisted of a procession of sorts, all the nurses in a group  following the kardex from bed to bed like it was the Bible at the beginning of Mass. The circus was led by the head nurse, same age as my mother. She generally arrived each morning with an attitude, and would heavily criticise the night nurse, pouncing on any inconsistency she found between the way the patient looked and what was written in the kardex; or how the story was presented.  Very theatrical. As report was read, she would examine each patient (“you said the IV was NS w 40 of K, why is it I see a bag of LR hanging?”) This included getting on her hands and knees to look under the bed, on occasion, as well as barbed sarcasm. Every day.  One day she chased a rat out of the ward, to the cheers of the rest of us…. but that is a whole nother story ( it was a very large and well fed rat). Yes, she was teaching us how to have standards and to follow them; but nowadays we would call her approach “horizontal violence’ or “verbal abuse” or “eating the young.”  That was the way it was in that time and place.

These days there is a national movement toward something called “Magnet Culture” – hopefully to eradicate that sort of approach. UPDATE: a former student emailed me after reading this, to alert me to some excellent work published by Sigma Theta Tau about Bullying in the Nursing Workplace.

New RN working nights

I was on eight-hour shifts, a day night rotation and soon found myself working nights about eighty percent of the time – the only time I was on days was on the head nurse’s weekend off.  The day I passed my Boards I was Charge RN whenever I showed up from then on. That was how I spent my first year as an RN. Since I was on nights so much, it meant that I got to be the person going through the gauntlet every morning. And yes, I did well at it – better than the others. In those days I could be just as sarcastic and unforgiving as others. I would spit it right back at the head nurse, to the astonishment of other first-year RNs on the crew.

I no longer treat others that way.

The usual night staffing was two RNs for up to thirty patients, and even then, I went out of my way to help the other RN be ready, which was appreciated. I promised myself I would never be the kind of nurse manager  that I was now working for, and that if I ever had anything to do with it, I would be kind and respectful.

In other words, it was the Work Culture from Hell. Got the picture? I can go on and on – you got me started, but like a bad dream, I need to wake up and remember that this degree of dysfunction is not the way to go through life. Let’s focus on positive ways to interact, here.

Teaching workgroup culture. learn it and live it.

What I do now is to incorporate healthy work behaviors into nursing school. Nursing school is not simply to learn about patient care; it’s to learn the way a professional person acts and thinks. Sometimes in the Fundamentals lab, a student acts as though the only thing they are there to accomplish  is to learn how to perform a specific skill according to the checklist. They don’t care whether others also learn, and don’t help their classmates or spend time coaching somebody slower to grasp the concept. Somehow there is a subset of students who think it’s okay to be a jerk to those around them while they focus on their own learning needs. This may work for Jack Sparrow, but will not lead to success in a hospital workplace.

This tells me that such a student has a learning opportunity.  Focusing on yourself is not the way to go through life. You are missing a major part of the ride.

(Note: a few years back I developed a one-page handout for how to act in the nursing school lab which I will send to anybody who emails me and asks for it)

How to Succeed as a team

Want to develop the habits of a helpful work group culture? here are some ideas. They are not a “Code” – more like Guidelines.

In both lab and clinical: Your work is not finished until the work of everybody is finished. Nobody sits down until everybody is able to sit down. If one person is getting swamped, we pitch in and help them. In the lab, it’s the students and faculty together, who tidy up and make the lab ready for the next group of students. Don’t rely on somebody else to clean up after you.

In the clinical setting: learn about  each other’s patients. Depending on how morning report is handled, this can be a challenge. If it’s a group report that’s easy; but if it is nurse-to-nurse report, you have to go out of your way to do this.  Find a way to check in with the other staff nurses (or the other students) after an hour or so.

Nobody lifts or transfers any patient by themselves.  There is a strong evidence-base out there regarding nurses and prevention of back injuries, so we have an important reason for this. Some wards have many “heavy” patients, and this attitude makes a big difference. But it’s also a chance to create and strengthen relationships among the staff.

say thank you. this goes a long way. there’s an old saying that “People may forget what you did or said but they won’t forget how you made them feel.” think about it.

use names. there is a parade of people through every hospital area every day. Learn who they are, and use their name in conversation.  You don’t have to go to Happy Hour with them or learn their kids’ names, but why not humanize the workplace? this includes housekeeping, the docs – everyone.

name tags. Ever been in a college class where the professor never learned your name, even by the end of the semester?  At my nursing school, we teach the same course to a different cohort each semester, there are fiftysix or sixty new names to learn. On the first day I always set up a system of using name tags, keeping them at the lab. The students collect at the end of each session. We call each of the students by name. They are not allowed to melt into the woodwork, which is often a surprise for the students.

Huddle. this picture was taken in Nepal, but any of my students will recognize this gesture. When I wave my hand at waist  level, they know that I want them to approach. I never have to raise my voice when calling them over. (and yes, they know i will not bite…) At lab and clinical practice,  I call a huddle every now and again. soon the students learn to call their own huddles without me.  Communication is a big part of teamwork. We use the time to share and to plan out our work and get ideas.

The Bottom Line about workgroups

The fact is, we all have a choice to create a healthy work culture, or not. which will you choose?

Should a New Graduate nurse relocate to find a Nursing Job?

Should I relocate to find a nursing job? (updated Aug 24 2012)

Before we answer the question: why not subscribe to this blog? Go to the box on the right and click where it says “sign me up.”  And while you are at it, buy my book about the time I relocated  (just for the summer), to teach nursing and work in Nepal, the Himalayan country in the mountains between China and India.  It won’t help you find a job but it will remind you of the value of your chosen career. Nurses make a difference in people’s lives, everyday.

And now – Catch-22

Two years ago one of the best students in the graduating class faced a problem: she was determined to be an ICU nurse, but getting discouraged. She’d sent out the resumes, worked her contacts, done everything. The local hospitals were interested but they pointed to “catch-22” – they would only hire if the person already had experience. And how to get that experience? get hired…….

She was offered a job as a nurse’s aide, but resisted the idea. So she took a courageous step. She moved to a large city in California,  where she didn’t know anybody.  It wasn’t San Francisco or L.A., or on the coast;  There was no surfing and no beach. Frankly, her new home was not a city with a lot of tourist appeal unless you like hot weather and dusty desert winds. There, she got the training and experience she’d set her heart on. And this year, with two years of ICU experience under her belt, she moved back to Hawaii. Now she works in ICU at the hospital that was always her dream job.

For her, the gamble paid off. She improved her career trajectory. Things fell into place for her; she was single, no kids, flexible, and resilient. She’d been a top student and always made friends along the way.

Destiny? Kismet?

It’s easy to say in retrospect that it was her destiny, but along the way she had to deal with loneliness and homesickness. During her time in Inland California she didn’t have much of a social life while she pursued professional goals. She worked mainly night shift.  Any of these things may have overwhelmed somebody else.

I think of her when any other new grad asks me whether their career would be better if they looked for Greener Pastures. Sometimes it works and sometimes it doesn’t. The National Council of State Boards of nursing would tell you a cautionary statistic: about 27% of new graduate nurses who do get hired, leave their job within the first year. That is a sobering number. There is never any easy answer.

Before you pack your bags and head to a new location, consult your personal Board of Directors, go back to the school you attended and tell your favorite faculty members about your plans. Ask their advice. Of course, figure out how much it will cost and what your budget is. List the pros and cons. Do all those things.

(added Aug 24th 2012): Travel as a means of escape

re-reading this, it occurs to me that nursing is still a field in which you are portable. It is amazing that you can find a job thousands of miles away, and largely be able to apply what you learned where you are now. The consistency between hospitals throughout this great land did not evolve by accident. In 1978 I moved from Boston to San Francisco with my girlfriend. We spent eight weeks driving cross-country, seeing all the National Parks and we both got nursing jobs well before our savings ran out. It was glamorous! We were leading the lives we dreamed about! We were grownups!  How could I advise the next generation of nurses to be anything less than that?

So… most of all, take your courage with you. 

Let’s get philosophical for a moment.

You’re young, you’re out of college. You chose a major that leaves open the possibility that you *could* take your skills anywhere in the USA, walk in the door, and have a paycheck.

Back in the Day, in the times when there was a nursing shortage, nurses used to do that all the time. There where nurses in my generation who had travelled the USA this way, taking a hitch in New York City, San Francisco, Chicago, Honolulu (of course) and Portland, Maine.

Wherever you go, it will be an adventure. For the rest of your life, you will have a story to tell. It will be a part of you, even if you return home, never to leave again.

You will always have people listing the reasons not to do it.

But you will never know, for sure.

Part Two “Getting Your Foot in the Door” for a nursing job

please consider buying my book on nursing in a Low Income Country. It won’t help you get a nursing job, but it will help you remember why we all do this job.

Disclaimer: while you are awaiting a nurse’s job, go to the National Council of State Boards of Nursing website. This is the repository of legal advice regarding all licensure issues. You will do a better job threading your way through scope of practice issues, if you are well grounded in the principles behind delegation and license requirements. ( and it will also help you on NCLEX)

Pick me! Pick me!

In today’s job market for new graduate nurses, “getting your foot in the door” is a catch-phrase. The goal is to identify yourself as a person and not simply be among the pile of resumes on the desk in Human Resources. There is an unspoken plea “if only you got to know me as a person, you’d like me so much you’d be compelled to hire me.”

We’ll get back to this last thought. If you are thinking this way, it means that your self-esteem is being eroded by the frustrations of a job search in today’s marketplace.

Read the previous blogs in this series

In a previous blog I gave suggestions as to strategies to get your foot in the door while you are still a student. What if you have graduated and these have not worked for you? In that case, the conventional wisdom goes, you can still get on the payroll by taking a job within the hospital in some other role, such as a ward clerk or nurses aide. Should you do it?

The Great Unknown

There is no “one size fits all answer” to this question. Some other time I will explore how this situation was created, how the health care industry got to this point, how the hospitals seemed to have decided this was a good strategy, and how it has worked.  To do that would require a deeper exploration of health manpower issues related to the work of Peter Beuerhaus and the interconnected State Centers for Nursing. Probably deeper than you want to go, right now – your problem is to navigate these waters, you don’t have time to contemplate who created the sea.

The Promise of the future

In some cases, taking an aide job works fine: You take the aide job, get processed, and somewhere over the next six months you get transferred into an RN position as these get opened up. Good for you. 

In other cases, you find that you are the tenth new graduate nurse hired into this position, you will need to wait your turn, and the first person in line has been waiting theirs for a year. Not so good for you.

Variations on the theme

One local hospital decided to do a major Informatics upgrade, installing a state-of-the-art nursing computer system, and hired about two dozen new nurses. Each was trained on the computer, then served as resources for the existing staff during the implementation period. This seemed to work out well for all parties: the hospital got the new computer system up and running, the new nurses got hired eventually into nursing jobs, and the new nurses also came on board with advanced training in the computer system. 

Limbo

There are two dangers of taking an aide position. The first is easy to see: what if there are still not enough RN positions opening up, to accommodate all those waiting in line. I know of one hospital unit where there are now seven such aide positions, and each of the persons in that role has passed their NCLEX. they are legally entitled to practice as a Registered Nurse.

Scope of Practice

The second danger is less easy to see, but real nonetheless. Here is where the term “Scope of Practice” comes in. For every position in a hospital, there is a job description. A carefully laid-out list of skills, tasks, knowledge and accountability for every player on the field. In the Policies and Procedures for every hospital, there is always a statement that says every employee will adhere to their Scope of Practice. It’s simple enough when you look at it, and it is a critical policy to protect the hospital from untoward liability – the hospital has an obligation to supervise events that take place inside.

The problem you face is an aide job is, you must only practice as an aide. Even if you passed NCLEX, if you are hired as an aide, you sign the chart “jane Smith, CNA” when you do an activity. You may only accept tasks delegated to you that are within the hospital rules.  You may not give meds, not even if it meant you were doing the RN a “favor.”

Telling a War Story to illustrate the point

This happened to a friend of mine. She graduated nursing school and took an aide job on a cardiopulmonary floor. She was very articulate and verbal, eager to use her assessment skills. One day at work, there was a COPD patient on oxygen with an order to titrate to keep the SaO2 greater than 90 %. On morning rounds she took the SaO2 and adjusted the oxygen while she was there. She did not tell the RN until a few minutes later. It didn’t matter that the assessment she made turned out to be correct, or that the action she took was within the parameters set by the Medical Doctor. She got a letter of reprimand. Another time a patient had pulled the IV apart and the nurse-practicing-as-an-aide put a gauze bandage on it and held pressure, instead of getting the RN immediately. This was probably the immediate action the RN would have done, but since my friend did it independently she got another reprimand. She was suspended from that job.

In the hospital’s defense

To the hospital, the need to maintain control over these things, over-rode the idea that the person involved was technically correct. In the long run, nurses everywhere need to maintain the authority to define nursing practice. We have the licensing rules for a reason. But the outcome was devastating to the individual involved, in this instance.

For this person, the foot-in-the-door strategy did not work. She left that job, and had a lot of self-doubt. From there, though, comes a happier ending. She talked to some of the faculty members that taught community health nursing, and learned that if she were to work through an agency she could get a per diem RN position  working at a nearby prison, providing health services to the inmates. Soon this got her more hours. She was also  using her full knowledge and scope of practice within the policies of the agency that employed her. She is happier now.

The bottom line

If you use this strategy, be sure to explore the ins and outs of delegation so that you don’t get caught in this trap.

Tomorrow’s blog will answer another question: Should you relocate?

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Part One “Getting Your Foot in the Door” for a nursing job

Jan 19th 2012 Update: link to a good blog on The Hidden Job Market, which is another angle on foot in the door…

Foot in the door

This is one in a series of blog entries written for young nurses. Take a look at the previous blogs about resumes, what to put in a cover letter, how social networking can hurt or help you, and ways to look at your portfolio. If you are a nursing student, you can start now to think about these things. Please share with others.

While you are at it, go to Amazon and buy the book I wrote about Global Health Nursing. It won’t help you in your job search but it will give you a window into a very different kind of nursing and it will help you remember the best reasons you chose nursing in the first place ( I hope).

The basis of the foot in the door strategy is simple:

A) In school: If the organization where you want to work hires ward clerks, nurses aides, billing clerks, etc, get a job there while you are still a student.

B) as part of school: If you want to work on a specific unit of a hospital, try to do clinical there through your school.

And

C) after graduating from school: If your target is a hospital which is not hiring for RN positions, apply for a job as a nurse’s aide or computer tech or anything, so you can become an internal applicant as opposed to an external applicant. Many large organizations will offer positions from within, first.

Let’s take these one at a time.

A) working part time while in school.

Nowadays it’s less usual to be a nursing student who does not work in some part-time job, somewhere, I’ve had students who worked as servers, telemetry techs, billing clerks and even as hula dancers at the big hotels on Waikiki.

You might as well be working in a hospital. Don’t underestimate the job of being a ward clerk. A ward Clerk will become familiar with the systems by which the hospital actually runs;  A clerk  gets into the chart everyday; and a clerk has a daily opportunity to become literate on computer systems such as EPIC or MediPro.

Here is a Pearl of Wisdom: Many of the older RNs nowadays don’t have the computer skills for EPIC are reticent about learning on the computer. The more you become proficient at EPIC or some other system, the more you can use this as a sales point for your resume. You are in the tech generation!

If it’s a nurses aide position, most hospitals will only hire you if you already have the Fundamentals course and some clinical under your belt, and often the state will require documentation that you have enough training to be equivalent. This varies state-by-state.

B) through school, as part of clinical, especially during the last semester

Future employment advice if you are doing clinical at a place you want to work later.

General advice: don’t only focus on the patient.

Oh, you need to do excellent patient care. You need to prepare well, be organized using a “nurse’s brain” and you need to be “on it” every day that you are there, using critical thinking and applying what you learned in class. But you also can benefit by adding some extras. You’d be surprised how students miss the little things: learning the names of the ward staff, (then following through by using people’s names when you talk with them), being polite to the housekeeping staff, (you can’t do your work without them!) and relating to the ward staff like future colleagues. On many hospital floors, the staff is already looking at you to evaluate your potential. Hate to put pressure on you, but it’s true. They are taking notes.

Specific advice for seniors:

Most schools nowadays incorporate a senior practicum, in which you are no longer in a clinical group, but are assigned to work one-on-one with a preceptor.

You don’t always get assigned to the floor you want, but that’s not the end of the world. There is strategy to apply here. For example, at one of our medical centers the Medical-ICU is considered to be the among the best placements; but they have never hired a new graduate and there is a waiting list of experienced RNs who wan to work there. So – you can get ICU clinical but it won’t lead to a job there.

If you don’t get placed in ER or ICU, it’s NOT the end of the world. My usual advice is actually to work on a Medical-Surgical ward, because the skills of organizing your day, setting priorities and making decisions about psychosocial issues are ones which apply to any setting. A few years back we had a student whose goal was to be a CRNA and he did his senior semester practicum in the O.R.  He enjoyed it, but it didn’t really help him learn the assessment skills he needed – he focused mainly on the surgery and on sterile technique. Right after graduation he got an ICU job, but did not do well there; I think he would have done better if he’d done medical surgical and gotten solid organizational skills. The O.R. seemed good superficially but turned out not to be a good “fit.”  Having a placement that meets your needs now is actually more beneficial than getting the dream placement if you can’t make the most of it. Have a heart to heart with the clinical placement coordinator as to what you really need, not just what you want.

The preceptor is critical. You need to know that when it comes time to apply for work there after graduation, about fifty per cent of the input as to whether you should be hired, comes from the preceptor. Recommendations, the interview, the cover letter? Nowhere near as important. When you apply to that hospital for a nursing job, highlight the name of your preceptor in the cover letter.

Read up on how to have a good relationship with your preceptor.  There are some great articles about your relationship with your preceptor on the Web.

The next thing is to consider work behaviors, and for that I have a story. Two years ago one of our senior  students took an ER job right out of school at the hospital where he’d done his senior practicum. This was a “success.” I asked him about it and he said:

“I took your advice”

Oh? ( couldn’t remember which advice he meant, I give lots of advice. What I am writing here is something I have preached for years, but don’t ask me to recall every single thing.)

“Yeah, I knew I needed to impress them with not just my nursing knowledge, but my work ethic. So, I never sat down when I was there. If there was something going on, I offered to help, but in the quiet times I did stuff like defrost the refrigerator, clean the nurse’s station counter with rubbing alcohol, and tidy things up. I didn’t brag about it, but everyone sure noticed.”

So what he was saying was, he was neat and cleaned up after himself, in addition to using checklists and following protocols. He was the kind of guy who showed up to lecture class or lab with a to do list, and I bet if I spoke to his mom he also made his bed at home and helped with the dishes and chores. ( I never did speak with his mom, this is a guess.).

Even if you don’t have your foot in the door, ask yourself whether you have this kind of attitude at which ever job you now have?

Tomorrow:

Situation C – getting an aide job *after* nursing school.

This blog is 1,316 words – long enough to digest in one day; I will break it in 2 pieces. The last part of foot-in-the-door is when a hospital has enough RNs but will consider hiring you as a nurse’s aide even though you have a BS and pass NCLEX.

Til then, share this with every nursing student you know, and Stay tuned!

You graduated from Nursing School – now what?

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In a previous blog I wrote about having a personal “Board of Directors” and I said it was worth a million dollars.

It is. Every new graduate nurse needs to recruit their own personal Board, and keep one going, throughout their career.

What it is and what it is not

It’s not the same as having a mentor, and it’s not the same as using your friends as a sounding board. You will change mentors over the course of your career, and your friends probably are your own age with similar backgrounds, which is not what you want. A Personal Board of Directors needs to be diverse enough to give you the perspective you need. Ideally, your personal Board will have people with a broad perspective on trends, it will include people who work in areas other the health care, and they will be aware of your goals.

Your life does not just happen.

The basic idea is to conduct your life like it’s a business. In nursing school, the students study patient care to the exclusion of everything else. I personally love nursing as a career, but the single decision that set the financial difference in my life was that of buying a house back in 1983 which we later sold at a dramatic profit. Didn’t learn that in Medical-Surgical Nursing class!

Doesn’t look like much, does it? We bought in 1982 and sold in 1999. It came with 80 acres of land. It was bigger on the inside, and we filled it with love. Nursing school does not prepare you for real estate.

Prior to having kids we seemed to never be short on money; then with two kids we needed to budget. I had my job as an ICU manager for nine years; was it time to move on? How much to spend on a car?  There was nothing in nursing school  that covered how to make these decisions.

Should you use a Ouija Board?

Should you go to grad school? Should you change geographic location to get a better job? These last two decisions seem to be on the mind of every new graduate nowadays since the job market has changed, I think I have been asked this recently by a half dozen young nurses. When you get a nursing job, you will also make decisions about pensions and benefits. As a young person this always seem incongruous, but it has an impact waaaaaay down the road and there comes a time when it is closer and closer.

It’s not like a hospital gown

The answer to all these questions is that there is no single answer. Unlike hospital gowns, one size does not fit all. Once you have joined the procession down the aisle and been handed the diploma, you are ready to lead your life.

Now what?

The answer is, now you go ahead and lead your life.

My wish for your future career? happiness and joy away from work to create balance in your life. If you have kids, I hope they are as wonderful and amazing as mine were!

Who to ask to be on your personal Board

This is not like conducting job interviews. In many cases, you have already been getting advice from your parents, and they should definitely still be on the list of people. If you have a favorite past professor, that would be a good person to ask. If there is an auntie in your family who is a nurse, or any body with a background in nursing, ask them. For me, my “Board” includes

a) three of my siblings,

b) my parents (my dad is always frank and blunt),

c) my two daughters; ( when they were little we used to always take time to explain all financial decisions, then there came a time when we soilicited their input. I still do.)

d) two persons I taught with twenty years ago in Maine;

e) a nursing faculty in Florida who I knew when she was in Maine;

e) another nurse now retired who is also a Methodist Minister;

f) two guys I used to play music with, one of whom is a computer programmer and the other is a school guidance counselor; and

g) two friends from college who are now attorneys.

These are the core. I have other people I sometimes call, such as the widow of a doctor I used to work with thirty years ago.  Along my life, people tell me I am a very good networker. Being able to network with people is something every professional person needs to cultivate. In a past blog I said that nursing school is not just about the grades, it’s about the relationships. That is true in real life.

Cloudsource

If you are not familiar with this term, you should be. It was intended to describe a company that puts all it’s IT department on the web. But one variation is to disperse the expertise you rely on, over the internet. You probably already use cloudsourcing. For a new grad nurse, I would define cloudsourcing as  asking cyberspace for the answer to whatever question you face.  When I wrote my book, I cloudsourced some of the editing, by sending sections off to some close friends and asking them what else I needed to include to make the description clear. Last summer I needed to write a report for a Medical School in Kathmandu Nepal, and I cloudsourced it, asking for feedback and editing from a bunch of people in USA. I blitzed through six drafts in three days, the finished product was very professional, and it made the impact I needed it to make. (please note, this was not the same as plagiary!)

You can cloudsource your personal Board. The idea is, they do not have to be people you see in person, they can still give you advice from far away.

One Key to having a Board

Once you have this group lined up, don’t expect them to tell you what to do. Their best role is to help you ask the right questions of yourself, or to help you figure out how you want to accomplish something. Their role is to help you cover all the bases when you are making a major move.

I am sure I will edit this in the next couple of days, but this is a start. I suppose the bottom line for every new grad is, to reach out to those around you, in every direction, and use all the resources out there, even if they do not pay off right away.

and lead your life.

Use FaceBook to JUMP START your nursing career!

This is part two of my blog about social media and how it impacts your search for a nursing job.

We don’t need Sherlock Holmes to investigate you.

Yesterday I wrote to alert you that your potential employers were conducting internet research on  you before they even decided to interview you. It’s true, and I got a comment on the blog from somebody to whom that happened. Keep reading to find out what happened in that case…..

Have you ever looked at somebody’s profile?

The whole premise of FaceBook is that people are nosy.

More young nurses are internet savvy. When they join the workforce, they are just as clever at doing a websearch as you are, and they are transforming how the web is used to supplement the hiring process. Yes, maybe the manager of the nursing floor is older, but it’s common practice to allow current staff to participate in the interview process, and if they decide to include some young nurses on the committee, I guarantee that every candidate will be Googled and checked out on FaceBook. We have HIPAA to protect the patients, thank God, but there is no HIPAA to protect you – FaceBook is free speech, sort of……

How will you do?

There are two sides to this, and they are every bit as important as writing a good resume and cover letter.

The first is the negative side.

Many college students are naïve about the downside of FaceBook. The negative side shows up  when the potential employer sees mainly pictures of you drinking or partying, gets the list of books you read, movies you like, and music you listen to – and disapproves. Sees your friends dressed in Heavy Metal outfits and reads status updates that sound like you were angry and sarcastic all the time or perhaps notices that you do a lot of “drunk-texting” at three in the morning.

Fix those things. For a list of ideas as to how to fix those things, go to yesterday’s blog.

“420 Friendly”

I only know what “420-friendly” is, because my students told me, and I have bookmarked Urban Dictionary.  If your profile is public and your tastes run toward a lot of heavy metal, goth, “420,” or substance abuse, don’t be surprised if the person Googling you goes on to the next job applicant’s profile. Yup. It’s true. If you put it there, it’s public and it’s fair game.

Now the positive side.

Which is this: it can work in your favor, all you need to do is to think of ways to make it happen. Think of your internet presence as if it were your portfolio. Yes, nowadays its trendy in nursing education to gather your best academic work to create a file on your progress through nursing school. The theory of gathering a portfolio is that this will help you to present yourself as a new professional. The downside of a ‘portfolio’ is that it’s hard copy and even if it’s wonderful you probably only have one copy. You can’t share it freely without making sure it’s returned to you. Portfolios don’t photocopy well. Nobody sees it unless they ask for it. Wish it were otherwise, but hey – that’s how it works.

For all intents and purposes, this idea has morphed into something else altogether now that electronic media has taken off like a rocket. The paper portfolio has been left behind.

You already have a portfolio, whether you think so or not.

It consists of:

FaceBook;

Flickr;

Twitter;

YouTube;

Any blog you have ever done; and

Every time your name has appeared in the paper or on a website.

The next step for you is to actually take charge of your Internet image, just as if you were a politician or celebrity.

GOOGLE YOUR OWN NAME!

Accentuate the positive

Eliminate the negative

latch on to the affirmative

(Don’t mess with the in-between, as the next line of the old Arlen and Mercer song says).

Do a total makeover on your profile.

Take control of it, and use it to sell yourself. Find ways to post photos or videos of the positive activities you engage in. Take an inventory of the nice things about yourself that you want people to know. If you don’t have something in your informal internet portfolio, go out of your way to put it there.

Here is the update from yesterday’s blog comment. A subscriber who read yesterday’s blog emailed to say he’d put his resume on LinkedIn a few months ago. Only yesterday, a  nurse manager from a teaching hospital on the mainland called and offered him a job (!) And in the course of the phone call, it turns out that the manager on the other end of the phone had Googled the subscriber, viewed the entire YouTube clip of the subscriber’s wedding including the reception, and taken  special notice of the groom’s chemfree behavior in a social setting. The manager also checked out the web sites of previous employers and other LinkedIn connections.

LinkedIn is sort of like “The FaceBook for Grown-Ups”

Why should your employer pay for a background check when they can find so much free info that you put there yourself?

They need your permission to get a written reference from your past employer; they don’t need permission to Google you.

Ten years ago this may have been spooky. Nowadays it’s becoming normal. In this case it had a warm fuzzy nice outcome.

What would the outcome be if it was your internet portfolio that was being Googled?

Please share this with every new graduate nurse you know, and consider subscribing to this blog.

Peace out

Is FaceBook hurting your search for a nursing job? 1 Corinthians 13:11

UPDATE: The National Council of State Boards of Nursing now has a video on Social Media for nurses. click here to see it! I strongly recommend that every nurse, new or old, become familiar with this.

Now you have graduated from nursing school and you are out there looking for a job.

Only it is  taking longer than you expected to find that dream job that caused you to study so hard and to dedicate your life to nursing school. Is it me? You ask. Nursing is a profession that demands a high degree of emotional investment, and if you are not getting a job, it’s easy to second-guess yourself down to the core. Think back to when you started nursing school. There were stories about nursing as being recession-proof. The Baby Boomers will all retire and who will replace them? When you started nursing school, you may have met new nurses who were walking proof of what a good career choice nursing is – and it’s true, just three years ago the job market seemed to be wide open compared to how it is now.

It’s the economy.

If you have the sense that the Clock of Doom is ticking, or the Sword of Damocles is hanging over your head, lighten up. Look around. The national economy is not some abstract thing that happens only on TV or to everyone else. In the USA we’ve had nine per cent unemployment, part of a worldwide slowdown and the daily news says Europe is in big trouble. Here in USA,  one party in Congress has done everything it possibly could to prevent expansion of health care funding, even though it is needed by an aging population. As long as the anti-Obama forces control congress, it is my belief that the nursing job market is going to be more difficult than it needs to be.  That’s little consolation while you are searching, but it should help your self-esteem: it’s not you.

Small things make a difference.

When there are five applicants per nursing job, sometimes there will be very little difference between the winning candidate and the second- or third- place candidate. It may very well be that some extraneous factor beyond your control, made the difference, such as which high school the winning candidate attended, something they said about being a baseball fan in the interview, that sort of thing. It can be very superficial. The best advice is to be yourself. When you read things like the paragraph above, there is a tendency to try to over-control things and get nervous about saying the wrong thing, or writing the wrong thing. You still need to wake up every day and be who you are. Make a schedule of exercise and time with friends.

There are things you can and should control.

That’s where social media and the internet come in. Any hiring manager will be under pressure to choose the best employee, and they will attempt to learn as much as they can about their applicant, which is why the “foot-in-the-door strategy” (which I will call “FITD”) is so important. I will discuss the FITD strategy  in a future blog, (subscribe now so you won’t miss it!). Now that you have graduated, though, the FITD strategy may not be available to you. In that case, it’s time to take another look at social media.

What does your FaceBook page say about you?

In the past several years we have all been cautioned about HIPAA, over and over again we are warned never to post anything about our patients, online. At every hospital you sign a HIPAA acknowledgement during orientation. All too often the student overlooks the idea that confidentiality affects them too. Your potential employer can use the internet to check you out. They can check your FaceBook page; they can Google your name; they can run a background check (for a fee) and a credit check (nowadays they pressure you to agree to this by putting a box on the application for you to check and give permission.  Did you give them the okay?).  They can legally learn a lot about you  – it’s all there for them to see. Most often, you are the one who put it there.

There are internet “reputation-monitoring services” available to which any employer can subscribe. The way these work is, they run a search for the name of the company, they scour the internet for any possible mention of a given employer’s name, and automatically send an alert to the Human Resources Department for review by a person, whenever the keywords appear. One the one hand, it’s all an invasion of privacy, but on the other hand, when we posted it to the internet, we enabled it ourselves. So, think about it.

Then do the following: Look at your own social media profile from the perspective of your potential employer. Be advised, the H.R. Department person who will look at your profile is likely to be a person older than you with a different sense of humor.   They will have a different idea as to what is funny or disrespectful. If you have to, find a person about your mother’s age who will look at your profile objectively and tell you what it says about you.

Set everything to private.

Learn about the privacy settings on FaceBook, and use them. You don’t have to make it easy for a stranger to find things they don’t like. From the employer’s perspective, a conservative approach is always preferred – if an employee is ever named in a lawsuit, it is inevitable for the attorneys in the case to dig up dirt to discredit that employee. Do you want to be that person? Take yourself out of the “search.” You can hide your FaceBook profile so it won’t show up on a Google search.

Rethink your friends and what they can tag you with.

There is an old saying among high school guidance counselors that to learn about a student, all you need to do is to look at their friends. (I hung out with the nerds in high school.  I was an Eagle Scout for gosh’s sake.  To this day that just about sums me up).  If your friends are presenting themselves in some out-of-the-mainstream way, a reader might conclude that you too, are out-of-the-mainstream.

Look at it from a risk management viewpoint

In the hospital’s defense, they know that errors occur in the hospital industry and they don’t want to ever get sued. They know that if they are ever sued for malpractice, the attorneys will dig up every thing they can on every person involved in a potential problem. Ask yourself: If I was ever sued for malpractice, would I want to explain in court, why I thought something on my FaceBook page was funny or hip?

Scrub your photos, your ‘likes’ and ‘dislikes.’

When I reminded students of this a year or two ago, one person approached to express his gratitude and admitted that it was long overdue to remove some fashion photos in which he appeared wearing only a speedo and  a Mardi Gras mask, covered with gold body paint holding a champagne glass in hand. Another told me she was prompted to remove photos that revealed that her entire torso is covered in tattoos. TMI! (tattoos are a generational thing, and so is body piercing. twenty years from now, it will be okay. For now, the HR person is the same age as your mom, and so it’s not quite in the mainstream).  Set the album to private or remove it altogether.

Go to Google and run a search on your own name.

You will be surprised what you find. Everything you have ever done on the internet since about 1995, is still there. If you ran track in sixth grade, your time is searchable. Don’t believe me? Try it.

That brings up another issue: what is Okay? well, if your profile shows that you are an active churchgoer, humanitarian, well-balanced, hardworking, dependable, loves small children and has a Golden Retriever for a pet – these are good things.

To be continued.

I present these ideas to raise your consciousness level about nursing as a professional career. You can find a Biblical Quote that backs me up. Please consider subscribing to this blog, and sharing as widely as possible. Go to the little box on the right that says “sign me up”

and while you are at it, check out my book on Amazon.

Tips about Letters of reference for new graduate nurses

“Would you write me a letter of Reference?”

Tips on recommendation letters for the new nursing graduate or those seeking a Patient Care Technician (“PCT”) job while in nursing school.

This is part of a series. If you like what you are reading, please pass this along to your friends and ask them to subscribe. It’s easy – go to the little button on the left that says “sign me up”

Updated Dec 2020. A reader asked me some very specific questions about recommendation letters from faculty. Should you just get one letter and send it to each potential employer? Will faculty feel bothered by repeated requests? Which faculty members should you ask for a letter? How do you go about getting these?

All of these are practical questions, and I will now reveal to my gentle readers, one of the hidden mysteries of nursing school.

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Rule Number One: It’s not only about the grades, it’s about the relationships. Think about it, meditate on it, we’ll get back to this idea in a minute. I am planning a future blog which will be titled “develop your personal Board of Directors” – an idea I borrowed from Tom Peters and other Management Gurus. You will need career advice for the next forty years, not just now.

First the nitty-gritty answers: Employers vary in how they want to deal with letters of reference, so you should follow the instructions given by the potential employer.( Rule Number Two).

Here is why. When the HR department gets serious about interviewing, they construct a file for each job applicant. Maybe they request that the applicant submit ten pieces of paper. If there are twenty job applicants, the HR department is now  tracking two hundred items for their files. For just one position. If they have ten open positions it’s two thousand pieces. You need to fit your documents into their filing system. This is a major reason they all have migrated to electronic systems.

Some employers ask that you collect all contents of the packet yourself and submit; others believe that a reference is more likely to be honest if it is sent independently. Still others will only ask for the names and phone numbers of references, and rely on a phone conversation with each person giving the reference. Nowadays, pretty much everybody uses the even more streamlined system and it’s all done via  website. You give them the faculty email address and boom, it’s done.

Rule Number Three, General principle: A letter or electronic reference is better if it looks like it was individualized to support a specific person for a specific job, and if it indicates that the writer truly knows the personal qualities of the applicant. So, if possible, one letter per job, addressed to the specific HR person or nursing department head. Most faculty nowadays save such letters as a Word document, and can easily cut-and-paste a new addressee. No problem.

So – when you ask for a letter, always supply the name of the addressee, the address, and the name of the job for which you are applying. My personal policy is to always include these in each personalized letter, and never to write a letter that says “To Whom it May Concern.”

Back up for a minute. If all you do is ask for a letter of reference, you are missing the program and failing to maximize your use of a valuable resource.

Which leads to rule number Four: Never use a faculty for a reference unless you ask them first.

For the faculty to write a letter of reference is voluntary. Nobody can make them do it or tell them what to say. You want to get an honest idea of their opinion before you type their name in. I had a student who was a bully toward her peers. It was obvious to anybody who watched her for ten minutes. What would you, as a faculty, write in a “recommendation” for such a person? This kind of dialog needs to take place long before you get to the point of using somebody’s name and hoping they will say nice things.

Always tell the faculty your plans if the plan changes as you go along. Keep them informed along the way. When you ask for the reference, do it in person if possible, be prepared to sit and talk for a few minutes. If you did something worthy of note when you took their class, such as doing a project or paper, bring or send a written reminder as to what it was, so the faculty can include it as a specific example of why they are recommending you. For me, I always direct any requestees to read this blog you are reading now.

Tell the faculty the deadline. Usually, when I have these kinds of meetings with students I will ask some questions and give feedback as to whether I think the person’s plans are realistic and how they can strengthen their case. This seems elementary, but it will always help you in the long run.

Rule number Five: From the beginning, develop a collegial  relationship with faculty members.

This one needs expanding. In ten words or less, the students who are more articulate about their goals, who ask for advice more frequently along the way, and who will use the faculty as a sounding board, are more likely to get better letters of reference when the time comes. If you are a student who disappears in the crowd and never draws attention to yourself, you miss an important part of professional development.

Rule Six: Outcomes, not tasks, in the letter of reference. In an earlier blog I wrote about resumes and how you should focus on outcomes, not tasks. To carry through with that line of reasoning, the goal of a reference letter is not simply to verify that you were in class or in clinical, it is to indicate what you did and how well you faced the challenges. You have to be honest with yourself as to how well you did and what you contributed, and the faculty will help you develop this kind of self-appraisal.  If you are still a student reading this, start thinking now about what you can do to set this up and make this happen.

In a future blog I will write more on the idea of setting up your personal Board of Directors.

To all readers of this blog: Merry Christmas and may your nursing days be merry and bright!

Tips on writing a cover letter for a nursing job

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Writing a cover letter

Tomorrow I will write a blog about Resumes, also known as “C.V.s” – Curriculum Vitae. This is a mystery for many new nurses.  And I might as well get on the Social Networking bandwagon as well…. social networking is no longer just an up-and-coming technology, it is a main way for your employer to learn about you. All these things go together, and some of the tips below will help you to develop a coordinated strategy as to presenting yourself to the world.

For New Nurses, entering the workforce.

 Among other things, I teach the senior-level management and leadership class every now and again when the school needs more than one section, and in that role I get to read and give feedback on cover letters and resumes for soon-to-enter-the-workforce nursing students. This is only one part of the overall process to find a nursing job, but people do need help constructing this. What gets put into the cover letter, exactly? How is the cover letter used? Who reads it? These are the simple questions, and there are also some more sophisticated ways to look at this – how do you frame an experience you have had? What if you don’t have much experience?

Here, in no particular order, are my top tips on writing a cover letter.

One page.

Keep it to just one page long, and hold it at arm’s length to check the formatting. If the content is placed haphazardly on the page, you can reformat it so it looks nice. I do think the presentation counts, and it gives the reader a subtle assessment of whether you are computer-savvy, whether you pay attention to detail, or not. You should be able to state your case in just a few sentences, and leave space along the margins in case somebody wishes to comment on something.

Spelling and grammar.

Run a spell check. This seems basic, but people still don’t do it. ask a friend to read it and look for errors, as well.

use the name of the job you want

Name names  –  and name jobs. One thing to remember is that an H.R. office will be handling ten pieces of paper per job applicant (the app, the CV/resume, 3 references, background checks, etc) and they will do this for multiple jobs. do the math.  If there are ten jobs posted, with three or four applicants per job, the H.R. Office will be swimming in paper. They spend their day organizing paper, and you can help them by clearly stating which job you are applying for.Tip: if you are applying online, assign a file name that includes your own name, the date and the agency. If the H.R. department is computerized, it will help them find the file and send it along.

Research the organization. Hot and Cold

Maybe you already know the place to which you are sending your resume, in which case it’s a “hot contact.”  In that case,  if you have spoken to a specific person within the organization, or made any kind of personal contact, be sure to mention that person by name, or to address the cover letter to that individual. if you are applying to a place where you did clinical practice, be specific about the dates, locations and contact persons who might remember you.

But maybe not, in which case it’s a “cold contact.”  Google the organization to which you are applying, if it is a cold contact. Try to point out ways you can help them. For example, a recent student in Honolulu wanted to work at UCLA Medical Center, and was a very strong candidate because she was fluently bilingual in English and Korean. UCLA serves L.A.s’ Korean community, and the student knew this. But the student originally failed to highlight her language skill. She moved it to the first paragraph and also described it more thoroughly on the C.V. itself. She got the job. She probably would have any way, but – this guaranteed that the language skill was front and center.

Explain stuff.

Don’t assume that the reader knows what you are talking about when you write: “server” for example. Maybe they think it’s just a waitressing job; but when you say “server for dinnertime shift at two-hundred seat restaurant with eight tables including beverage service and high customer turnover, received Employee Award for customer service, worked 28 hours per week to pay for school expenses while attending fulltime” then the reader gets a different impression.

Or for a prior health care position, one recent student put down “billing clerk.” After a few questions, it was easy to re-frame it so that it read “billing clerk responsible for computer program that covered twelve million dollar revenue stream and generated monthly reports of hospital financial data, worked with CFO to develop monitoring systems” – that is more of an eye-opener. Or a student who was a veteran and put down “U.S.S. Buffalo engine room” – this was re-framed to say, “the mostly highly trained category of job descriptions in the Navy” or some such. When i was proofing that one, I did a web search on the USS Buffalo, but an H.R. person is unlikely to use the web the same way.

Think of generalizable skills.

A generalizable skill is one which can predict success in a variety of jobs.  As above, the entry on being a server allows you to talk about how you can multitask, use the computer order-entry system of a restaurant, and deliver customer service as an incentive to getting better tips. One recent student worked 28 hours per week throughout nursing school, and was able to reframe this to highlight her dedication and perseverance to overcome odds through hard work.

Please feel free to comment, and to share this with other new graduates.

I will focus a bit more on the CV, as well as the interview process, in  future blogs. I wrote a blog lasty summer about my own CV…. you may find that one amusing. The rules are different when you have twenty or thirty years of experience. You have to start somewhere.

In the meantime, read my book about nursing in a Low Income Country, and feel free to visit the FaceBook fan page. It own’t help you get a nursing job, but it will remind you of the powerful value that nurses add to society and to life.