Should a new nurse go to graduate school right away if they can’t get a staff nurse job?

Funny you should ask… I will answer in a minute, but before you read on, please take a look at my book about hospital care in a Low Income Country. My book won’t help you get a nursing job, but it will remind you of the value of nursing.  And why not go the right of the screen, and click oon the little box that says “sign me up” ?????

It’s a tight economy for nurses

The job market has changed from just two or three years ago. This past month, three different new graduates told me they were worried about their prospects of getting  a staff nurse job. Each of the three asked me the same question.

“If I can’t get a nursing job right away, should I go to graduate school?”

And

“What track should I take? Is it better to be a nurse practitioner or a nursing administrator?”

The pros:

You will have more credentials.

You will be doing something productive.

In the long run, you can get it over with before you have other responsibilities.

The cons:

Running up more debt in student loans.

Not having enough experience to draw upon.

Still having job search trouble after graduating.

As always, the answer that fits you depends on your circumstance. If you are young and your parents will still foot the bill this is different from being say, thirty and with two kids.

My story

For me personally, I went to grad school after being an RN for a year, worked in ICU while in school, and then took a management job for ten years after grad school. I knew I wanted to teach eventually, and the MS degree was always in the back pocket, just in case. By the time I made the move, I had two kids and a house and a mortgage; I was living in rural Maine far from the nearest graduate program. Having the credential allowed me to make a career change within the nursing profession that would have eluded me if I needed to go back to school right then. So, the timing was auspicious.

I did my grad school in a “Clinical Specialist” track, what would now be lumped in with other ARNPs. There was a window of opportunity in the nineties, when the ARNP standards were revised during which I could have become an NP with nine more post-Master’s credits, but I decided not to at the time. The classes would have been 65 miles away; it would have cost $2500; I would have needed to do a clinical placement in an MD office practice. Finding the MD sponsor would not have been a problem, but I always did ICU and the thought of looking at otitis all day or dealing with management of HPTN, was not appealing. Those things are important but in my heart of hearts I wanted to be doing hospital-based acute care.

Call me a traditionalist.

How many NPs do we need?

For awhile there, the federal government was subsidizing the expansion of NP programs around the USA. There are statistics to say we need these primary care providers, but I wonder. When layoffs and restructurings happen in the health care industry, reductions in clinic staff always seem to involve the NPs before the doctors. I just don’t think the underlying reimbursement structure is well-established enough. And if you are a family NP? There are fewer kids nowadays and family care includes a lot of clients who lack insurance. This has been true for decades. Even in the 1980s, both of the two pediatricians in town had less take home pay than I did as ICU manager of the local hospital (they had office overhead, employees, etc).

What does an ARNP do all day?

A friend of mine in Maine is a women’s health APRN. She spends her whole work day doing contraceptive counseling, pelvic exams, and fitting diaphragms, IUDs and depo-provera inserts. She loves what she does. Simply gushes with enthusiasm. I don’t want to deny the importance of women’s health – it is critical. But would I want to do that? No way.

There is significant Continuing Education required to be an ARNP – to maintain certification takes 80 hours per year (varies from state to state).  this is a sizeable investment of time and money. Yes, we need to stay current in our field. But this is time spent away from patient care activities.

How to fix the nursing job market

In My Humble Opinion, we need to fix the gridlock in Washington DC before the health care situation will be improved. We have a series of paradoxes: lots of patients; lots of need; a huge cohort of older nurses preparing to retire in the next few years; and a larger supply of newer ( younger) nurses waiting in the wings. But jobs in health care are being held hostage by Congress. We need to get some grownups in charge back in the Capitol Building.

Tips for nursing students attending your first Job Fair

I invite you to subscribe to this blog. click on the button at Right. Also, check out my book.  It won’t help you get a job but it will remind you why nursing is important.

Job Fairs?

Here in Hawaii we don’t often conduct a “job fair.” It’s  not how things are organized here.

but now I have readers from That mythical place known as The Mainland,  and a Job Fair is one of those ways to get face time with people who are involved in hiring.

Here is how it works: somebody gets a large public space, like a hotel ballroom during a conference, and rents out booths to exhibitors or vendors. Often the organizer is one of the Nursing Specialty Organizations or the State Professional Association such as ANA-Maine or The OR Nurses. The revenue from the vendors is part of the conference budget. The sponsoring organization brings the nurses, the vendors are promised that the schedule will include free time for the attendees to wander around. Often, the conference program will list all the vendors or exhibitors in advance.

Here is a story about Speed Dating

Ten years ago was the first time I taught the senior level management and issues class at a small college on the east coast. We had thirty seniors, since it was a residential college they were all about twenty-two years old. Our career center organized a small job fair right on campus, to which about two dozen local employers came. The Job Fair was held on the day of the class, and I decided to cut class short so as to allow all the students to attend.

I wandered down to the job fair myself about fifteen minutes later and watched what happened. Where was everybody? Half the students were gone within a few minutes; they had strolled through and spoken to nobody. The others were standing in small clumps on the other side of the room from the vendors. This is not good, it’s like a junior high school dance, I thought to myself.

Within a half hour all the nursing students had left. We were a bit embarrassed, as the hosts, because we had hoped that each vendor would make some kind of meaningful contact with our group. Fortunately we had not charged the vendors very much, and nobody came from a long distance, or I would have felt like we should return them their money.

The Assessment

At the next class meeting we spent a bit of time talking about getting over your nerves when you make a “cold call” to a job recruiter. The students expressed the idea that they didn’t know how to start the conversation, or how to act. Now, when these same students were in uniform in clinical they were confident and verbal, comfortable with the hospital setting where they meet patients and families every day. But somehow when the setting changed, the confidence took a hit.

The Plan

We needed to role play a job interview, and we needed to have a better strategy. So, the next semester, when we repeated the Job Fair, we did things very differently.

The week beforehand, we role played an interview, and assigned readings from the book using the chapter on the hiring process.  This included a review of basic body language that people fall back on during times of threat or stress.

The Implementation

The day of the job fair, we did two things. first we paired the students, and gave them an actual role to play. for each booth at the job fair, one was assigned to be the Talker, and the other was assigned to be the Observer.

The Talker was expected to ask all the questions and do the interacting. The Talker was expected to bring a list of questions to ask. At any interview there is always a time when the job seeker is asked “what questions do you have?”  – this is a time where the Job Seeker can display their verbal ability and enthusiasm. If you are the kind of person whose has a brain cramp at this moment, it helps to write the questions down and practice them. There are some standard questions used by a lot of interviewers, and you should be prepared to answer.

The Observer was given a small checklist, and told to stand back and – Observe. Complete the checklist during the interaction, as if this whole thing  were an experiment in a sociology class.

The checklist was simple. it included:

eye contact?

handshake and introduction?

“open” body language?

asking three questions?

answers to questions?

looking enthusiastic?

positive statements?

Each pair was to use this at six booths, taking turns so they Talked three times and Observed three times.  In between each booth, the pair was assigned to go to a corner and debrief, so the Observer could give their partner feedback as to how she did in meeting all the elements.

Picking the order of booths to visit is a strategy

I also told the students  to choose the order in which they approached each booth. If there was a vendor that was truly the one they really really wanted, they should go to that one last. If there was a vendor there representing some hospital or agency that was too far away or where they Talker never intended to apply, don’t simply omit this one. Go there anyway, and talk with them. You might find that they are more interesting than you think, and also, the stress will be lessened because there is nothing at stake.

The Evaluation

When we used this approach, the students stayed a lot longer, and after it was over, the vendors expressed their appreciation. Every vendor at a Job Fair works to send people who will be approachable and nonthreatening, and every Human Resources Professional knows that the person being interviewed will be nervous. The vendors could tell that the students were not so nervous as the previous time.

At the end of the exercise, the paired students submitted their raw notes to me. This wasn’t really “graded” but it did support the self-learning about socialization and seeing how you come across. The only way to do this better would be to video the interaction and allow people to have an instant replay.

One of the students said “it’s like Speed Dating for job interviews”  which is exactly what it was. The Observer partner was the “wing man” for the Talker, and the opportunity to discuss the interaction with a nonthreatening friend was very valuable.

You can go a long way with the dating analogy. Just because you talk to somebody does not mean you need to go down the aisle with them…..

It goes without saying that you should dress for a job fair as if you were being interviewed; and that you should consider writing a followup to each recruiter for whom you have a specific interest.

Look at the buttons below – please share!

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?

If you are finding this blog useful, please share widely. Also, in order to make sure you get all new entries, please consider subscribing. go the little box on the right, and click “sign me up”

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”

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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.

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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 resume for new nursing graduates

Tips on writing a resume for new nursing graduates

 Don’t miss the series

I am writing a series of blogs on the topic of making your way in the world now that you are being launched. I already wrote about cover letters for your resume. Please consider subscribing  to this blog. shar eit with your friends!

Future topics:

Some tips about asking the faculty for recommendation letters and how to enlist their aid;

My own response to the recent article on Medscape that asks whether there really is a nursing shortage; 

things you can do while you are still in school, that will help – the so-called foot-in-the-door strategy.

How to find a mentor will be part of your winning strategy – what I call assembling you personal Board of Directors. Than in and of itself, is a secret that is worth a million dollars.

To be sure to see these when they are written, go to the box on the right that says “sign me up” and click on it.

 The zen of resume writing

 To write a resume is always an assignment for the last semester of nursing school. The faculty is about to launch you like a rocket headed into outer space, and the resume is fuel for the trip.  Depending on the faculty for your senior level course, though, you may not get much feedback. Sometimes the person has not read many resumes in real life, or been a department head who interviewed any potential employees. They may not have the background to predict for you how a potential employer will react to your resume.  

 A resume is an exercise in zen, On the one hand, there is a formula for this. You need to have some dates, places, and accomplishments. But on the other hand, you also need to focus on what makes you special and what you wish to feature. If you can do that, your resume  will sing like a TV commercial. The question is, how to get to that point.

 Inventory your skills and pick your selling points

 The tendency is to write a chronology of your life. You will need to provide that sooner or later. But an important early step is to write down a list of what’s the most important, and prioritize those items. When you actually get to formatting the resume, find a way to put these first. If you can’t think of what would go here, ask the people who know you, or your mentors, how they would describe you.

 Overcome your humility

 There is something peculiar about nurses and nursing students. And especially if they were raised Catholic (like me). We are taught from  early in life that it is bad to seem like you are prideful, or to overtly bragging in some way. Take a minute and think about this. Then get over it. If you did something really good, here and now is the place to describe it – don’t bury it in the middle where somebody has to dig for it. Front and center! For example, a student of mine spent summer 2011 at a Mission Hospital in a truly remote part of Africa, where she delivered some babies, worked in the E.R., and developed skills of personal leadership while exploring some very high ideals of Christian service. She gave it exactly one line in her resume, and didn’t even follow the Outcomes Rule (below). She succeeded in a very difficult environment where more experienced nurses would have been overwhelmed. This was more than just a summer job in a USA hospital.  Say wha?

 The I word. is it really about – me?

Okay okay okay, it can be overdone – for example, go through the cover letter and see how often you use the word “I” – don’t start every single sentence that way – but usually nursing students are the last ones to fall prey to this problem. Don’t hide your light under a bushel!

 Focus on outcomes not tasks

 When I take students to clinical practice, the end of the day is occupied with writing a draft nursing note in the DAR format.  For a beginner, the usual first drafts of a note often consists of a  list of the tasks, not the assessments. For example: “dressing changed, tube feeding given, vital signs taken” etc. 

 When I read that kind of note, my response is “okay, but how did the wound look? What was the residual volume? Was there a problem with the B/P or the temp? what did you do about it?”  sometimes students take a while to ‘get it’ and start writing about nursing process others  take a little longer. When I read a note that says “wound is nine by seven cms, no undermining noted, scant amount of serous drainage noted.” Or “residual volume was less than fifteen cc, stool is soft, skin turgor normal.”  This gives a lot better info to the reader.

 The equivalent on a resume is to write:

 “2006-2011 – part- time server, Bubba Gump Shrimp co, Ala Moana Center”

 Or

 “2004 -2009 nurse’s aide, Hawaii Medical Center, SNF department”

Each of these could become much more valuable if they were reframed in the following way:

“2006-2011 – part- time server, Bubba Gump Shrimp co, Ala Moana Center. Assigned to six tables during busy dinner shift, including beverage service and daily specials, used computerized order-entry system. Received 2008 customer service award, worked 20 + hours per week to support myself during college. ”

 Or

 “2004 -2009 nurse’s aide, Hawaii Medical Center, SNF department. 50 –bed unit with average daily census of 35. Two patient populations – short term rehab after joint reconstruction and long-term post-brain injury  with severely altered mental status. Functional nursing model. Usual assignment was to share 12 patients with another aide. High emphasis on personal organization and accountability to licensed staff. Perfect attendance on rotating shift schedule.”

The key is, a well-written descriptor can guide the reader or interviewer with specific followup questions that are intriguing and beg to be asked.

 The original versions of each don’t get much of a reaction from the reader. The revised example, though, hint at skills that might also apply to a nursing setting. When a potential interviewer reads the revised examples, they are prompted to ask certain questions. “tell me more about multitasking?” “are you good with computers?” “what exactly did you do to achieve the customer service award?”  that sort of thing. The idea that they might be able to discuss this with you, makes them more likely to want to interview you as the next step. A well-written description can serve as a tease, begging for a followup from the reader or interviewer.

 Or the interviewer might followup with the second example by saying, “if I asked one of the licensed staff about what it was like to work with you, what would they say?” or “of those two groups, which was your favorite?” or maybe “how did you stay motivated every day when you knew that progress would be slow?”

 Outcomes, not tasks.

In summary, don’t simply describe what the job description was, focus on the what you accomplished. You want to portray yourself as a doer, even if all you have held were “worker bee” jobs. These sort of statements convey the idea that you have skills for accountability, dependability, and customer service.

 Final point for now

 If you have just graduated, be sure to put “(your name), BS Nursing, right at the top. When you pass NCLEX start putting RN right up there in big letters. You are applying for nursing jobs, after all, and you worked hard for that credential.

 I will continue this blogging theme  in coming days. Keep those cards and letters coming. send an email to joeniemczura@gmail.com with your question if you are too shy to add a comment. Feel free to browse this blog, and also consider buying my book about hospital care in Nepal.

Getting your first nursing job

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Yesterday’s blog was about writing a cover letter, I said I would write resume tips today, but we need to back up a step first.

how Human Resources department does their job.

Applying for a job is a process, with many steps and decisions along the way.  As with the cover letter, there are some elementary housekeeping rules for a resume. The Human Resources department of any given agency, will need to systematically organize all documents they receive, including yours. Typically, they make a file for each applicant, which can be as simple as gathering an oak tag folder, stapling the checklist of minimal documentation to the inside, and then completing the file by inserting each document as it comes in.

Do the arithmetic

Let’s say the HR department is working to fill ten jobs. There are five applicants for each, and ten steps or documents to gather before each file is complete. Simple arithmetic will tell you that they are trying to keep track of five hundred pieces of paper at any given time. It’s one of the reasons that so many HR departments try to computerize their process, but in the meantime, you can ease things if you label everything clearly. If there is a job requisition number, be sure to put that on the resume and cover letter. If you send the resume as an attached file, be sure to use a sensible name for it, otherwise the HR department may have to rename it when they save. For example “resume for Joe’s class”  is not useful. “Smith, Janet, resume for staff RN position at QMC Jan 2012” is helpful.

Screening function of H.R. department

There is a saying out there that the HR department’s job is to screen you out, as opposed to including you in. For each job, especially entry-level ones, there is a deadline by which a decision needs to be made. Since they don’t know you, any decision have to be based on what they do happen to know. It is very easy for them to use the completeness of the file to decide which ones get forwarded or not. So – you can also help your case by tracking the documents from your side. If a written reference or transcript was required, did you followup with your team to see that it got sent?

If you are applying for multiple jobs at multiple hospitals, make a simple grid of all documents that might be required, and set up a system to track all correspondence with each agency or hospital. Make a file folder for each possible place. You yourself can track the documents.

Know the time frame and work with the timing

During the application or query process, it’s okay to ask about the number of positions available and the time frame for decisions to be made. Nowadays many of the bigger hospitals will conduct a formal orientation for new graduate nurses every few months, with a specific start date. They can only absorb so many new nurses at a given time, and if you learn about this, you can work the calendar backwards to get an idea of timing. In other words, if the orientation starts Monday the first of the month, the hospital needs to decide who is on the roster by the fifteenth of the previous month. In that case, your part of the deadline is to submit your documents two weeks before that date. A month before the time the orientation starts. As more requirements are needed, the lead-in time becomes longer.

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.