Welcome to the PA State Nurses Association

As part of the ongoing career series, this article on career information for nurses is intended to help individuals with a topic that is just briefly touched on in nursing school and is usually completely forgotten in the day-to-day lives of working nurses. The information that follows will cover several topics related to the job search as well as helping nursing professionals stay challenged and prepared to face the uncertain employment trends in healthcare today.

Throughout the state of Pennsylvania there are different employment trends affecting nursing jobs. On the one hand, there is a nursing shortage being felt by healthcare facilities in relation to experienced nurses, especially in the areas of intensive care, the operating room, and even medical-surgical units. Nurses who are experienced, usually meaning 3 or more years in the specialty, are being recruited vigorously and in some cases being offered sign-on bonuses. In some instances, facilities are willing to hire new graduates into those specialties, spending the time to orient and train them extensively to fill critical staffing needs.

On the other hand, many healthcare facilities throughout the state are struggling to balance their budgets with the effects of managed care. In some cases, this means decreased extras such as over-time, salary bonuses, and hiring extra staff. The most severe reaction to this is the laying off of current personnel, the management decision feared by many nurses across the country. This is also handled differently from facility to facility, severance packages offered in some cases and short notices with no compensation in others. Currently, in Pennsylvania, there are isolated instances of lay-offs but this is not seen as the prevailing trend in nursing employment.

The candidate who is in the best position for job security and multiple employment options in today's healthcare setting is the multi-skilled, experienced nurse. Individuals who have worked in different areas within the hospital setting or who have worked in-patient as well as outpatient settings are apt to find more employment opportunities due to their flexibility. For those nurses not in this category, this article will assist you in marketing your current skills.

Nurses, in general, would benefit greatly from learning various career management strategies. Historically, nurses have had little education regarding managing their careers. Nursing schools spent little or no time preparing students on how to market themselves to employers or how to position themselves to take advantage of upcoming professional opportunities. Looking back over the history of employment trends in nursing, there have always been times of excess and shortage. Many graduating classes of nurses had only to walk into the human resource department of their favorite facility, tell them they were available, and were commonly asked, "How soon can you start?" Also remembered, are the difficult times when after 6-12 months of searching, available jobs were limited to long-term care facilities or settings outside of the healthcare system as something other than a nurse. These cycles will always be repeated in healthcare.

It seems that today's trend is slightly different than those of the past. Enrollment has dropped in numerous local undergraduate nursing programs, in spite of higher enrollments in graduate level programs. The changes initiated by the advent of managed care have caused disillusionment in many nurses who have been in the profession for 10-20 years, and therefore some of those nurses have looked for greener pastures outside the healthcare setting. Also, the "graying of America" has affected the nursing ranks with the average age of today's nurse being 44, which will leave a large void in 15 or more years when this group is ready for retirement.

How can nurses in this current environment stay fresh and enthusiastic about their profession? By investing in nursing as a "career" as opposed to a "job". From new graduates to seasoned nurses, nursing professionals could all benefit from thinking of themselves as independent practitioners who are in control of their careers rather than employees relying on their institutions to guarantee their satisfaction and security. The following three ideas are offered to help nurses invest in their careers: self-assessment, life long learning, and independence.

Self-assessment - Self-assessment is a way for an individual to look within her/himself to determine various aspects of their personality. For the purposes of this article, it is the process individuals go through to decide who they are and what they want to do with their lives. By repeating this process periodically, nurses can remind themselves of the priorities and values that are important to them in their personal and professional lives along with the goals they wanted to accomplish as a nurse. Admittedly, priorities and goals change over time, sometimes they are simply forgotten or pushed to the side, but values are relatively constant. Performing a quick review of career goals, priorities and values can get individuals back on track and rekindle forgotten enthusiasm for future plans. Take a look at a sample self-assessment exercise, and see if you are in line with your goals and priorities in your career.

By doing this exercise, nurses can compare what they want from their career with what they are actually doing. If the priorities and values are at odds, then changes need to be considered. The best prevention for burnout and frustration is to be proactive, to make changes before the situation gets to that point.

If a nurse is frustrated with her/his current position, some time needs to be spent on deciding why and what can be done to increase their job satisfaction. Look at the following examples:

Does the shift that is being worked fit their lifestyle? Can shifts be changed or rotated to make life easier outside the hospital? Is there appropriate time for sleep, family time and recreation?

Are co-workers friendly and supportive? Can liaisons be established to create a nurturing environment?

Is there a lack of confidence in skills or communication that can be boosted by education or mentoring? Especially in facilities that require their staff to float from unit to unit, additional inservices or seminars in specialty skills can ease stress over unknown or infrequently performed tasks.

Does there need to be a change in skill level to create stimulation and challenge? At times, being too comfortable with a unit or position can lead to boredom and apathy. Maybe applying for a leadership position or advancing into a high-risk area associated with the current position can increase satisfaction.

Remember, sometimes change can be a great thing! Especially change which is
chosen and not forced upon us.

Life-long learning - Education should be continuous throughout our professional lives. After graduation from nursing schools, most new nurses don't want to hear anything about going back into the classroom or reading another textbook, but for nurses, continuing education is a necessity for professionalism.

Learning can be formal or informal, such as: reading professional journals and taking the CEU offerings related to the articles; attending seminars or conferences; participating in inservices taking place within your facility (whether it is related to your field or not!); researching pertinent information on the internet; or taking classes at the local community college, the list is endless. Almost anything you learn can enhance your nursing practice in some way, you never know when past experiences can help you care for your patients. Also, completing a Bachelor's degree or obtaining specialty certification can be an advantage in getting hired into certain positions or advancing within healthcare systems.

Another issue at the heart of continuing education is the speed with which medical information becomes outdated. Various sources state that medical information is outdated within two years. Considering this statement, professionals in the medical fields must keep updating their knowledge and skills in order to function competently and safely. Nurses must make it a priority to keep current. The ability to show prospective employers a running record of continuing education can show incentive and a high level of involvement in professional standards.

Independence - Career independence means taking control of your professional career. Although job security within nursing has become a fleeting issue, nurses could take a few tips from the business world and realize that they are highly marketable commodities. After graduating from an accredited school of nursing and being licensed through state examination, the title "Registered Nurse" gives individuals a lucrative position in the healthcare industry. Nurses are the primary caregivers in healthcare institutions, businesses that cannot work without their skills and time. Therefore, with the right attitude and preparation, nurses can choose from a wealth of career options and create a profitable future.

Self-assessment is an important part of career independence, without it nurses tend to get caught up with getting through the daily routine and loosing track of their ultimate career goals. Career guidance literature shows that adults will go through approximately 10 different jobs in their lifetime and 3 career changes! If nurses look at these statistics, it shows that people in every profession/career go through periods of change. Nursing is one of the few professions that offer such a wide variety of possibilities within the same field. When nurses decide to change settings, they don't necessarily need to leave healthcare. With insight into what values and priorities drew an individual into nursing, a nurse could go from hospital based care to community based to entrepreneurialism to the business world and still be a nurse.

Career independence means that nurses have skills that are transferable to numberless different situations if they focus on what is important to them and what they need out of their career. For example, if a nurse's love is Maternal/Child Health, they were probably drawn right away to the Obstetrics unit of their local hospital. They may be very happy on that unit for many years or forever if that is what works for them. However, if the time comes when the nurse needs a change and doesn't want to go to any other units within the hospital setting, there are other options. Birthing centers, home births, maternal/child health nurse practitioner, certified nurse midwife, lactation consultant, childbirth education instructor, neonatal advanced life support instructor, sales of medical equipment, storefront business for maternal and infant clothes or supplies, community support projects funded by the hospital or community resources for infants and pregnant mothers, websites for maternal/child health education, etc.

Nursing career options are only limited to individual imagination and perseverance!

There are large groups of nurses who have never written a resume and there will still be times when a job can be obtained without giving a prospective employer a resume. However, a well-written resume can differentiate you from the rest of the contenders when it comes down to selecting the best candidate for the job. Also, as discussed previously in this article, a resume is a great way of keeping stock of nursing skills and staying up to date with certifications and educational requirements.

There are three basic types of resumes: chronological, functional and a combination of the two. Nurses usually use the chronological format to list their previous employers in a time sequence and the positions held for each. Human resource specialists will state that it is not the form that is so very important but that the resume is accurate, easy to read and contains all the necessary information. Resumes are marketing tools for a nurse's career, they are to be used to highlight skills and education and may be the first and only impression that the employer gets of a candidate before an interview.

A fourth type of resume, sometimes seen in larger healthcare facilities, is the scannable resume. Learning what a scannable resume is and asking employers if they use them can make a difference in whether or not a resume is used appropriately. A scannable resume is one that can be viewed electronically and entered into a computerized database. The paper resume, which is written by the job seeker, is then usually thrown away. The scanned resume can then be kept for future use within that facility, entered into a national database of companies associated with that facility, and/or searched for key words that the employer has selected and placed into certain categories for future reference. If the specific key words that the employer is looking for are not found on the resume then it will not be selected as a possible match when the employer looks for certain skills or experience. Scannable resumes need to be prepared in slightly different ways from the traditional resume in order for the computer to correctly interpret the printed words as well as to find the key words. Key words for the nursing profession are action verbs related to nursing skills, such as: taught, managed, precepted, mentored, advocated, implemented, and so on. Regarding type fonts, some can be confusing to the computer program and therefore can cause misinterpretation of words or punctuation marks.

A CV or curriculum vitae is somewhat similar to a resume but goes into greater detail in respect to education, research, and publications and is usually seen in conjunction with advanced practice positions, teaching at graduate or doctoral levels, and research opportunities. The CV is generally two or more pages in length due to the required depth of subject matter.

A portfolio is another way of presenting credentials, work history and accomplishments and is being seen more and more in healthcare settings. Various nursing programs are having their students prepare portfolios for their job search. Especially for the new graduate, this document can be a highly effective way of presenting an individual for an interview. It usually involves placing copies of the resume, examples of accomplishments, letters of appreciation or recommendation, awards, certificates and so on in a binder which is then used to emphasize specific strengths to the recruiter during the interview process. There are specific ways to prepare the portfolio, guidelines can be found by logging onto the Nursing Spectrum website and reading the article, "Building a Successful Portfolio", by Valerie Restifo, RN, MA, MS.

There are several ways to get help with writing a resume, the internet offers a wide array of career guidance sites on which resumes can be drafted right on-line or guidelines are given to write resumes at home. Local community colleges usually offer courses on job search techniques that would include resume advice as well as interview and career planning tips. Resources are listed at the end of this article.

After the resume, hopefully the next step will be the interview. The resume is a first impression and a quick look at the skills offered to an employer. The interview is intended to find out if a prospective employee will be a "good fit" for the institution and the specific position applied for, however, it is also an opportunity for an applicant to see if the facility is the right match for them. Interviewing methods differ widely and can range from brief, general employment background checks to in-depth, behavioral based, extended sessions that cover personal responses to situations as well as detailed clinical questions. The process should be viewed as an opportunity for both parties involved to get to know each other personally and professionally.

Applicants should be ready to ask questions of the employer also. In fact, the general consensus among recruiters is that the potential employee needs to show knowledge of the facility they are interviewing with, and prepare questions they want answered regarding the position (other than salary!). The worst thing for an applicant to do is to be unaware of the facilities background or when asked if they have any questions, shrug and say "Nope!".

There are many ways to research a facility before the interview. When scheduling the interview, the applicant could ask for a copy of the job description for the position applied for and any promotional material available for the facility. Many institutions are on the internet which is an excellent way to gather details before ever stepping foot on the property. Read the facilities mission statement, check into the general and specialty services available, what is the size and location, who owns and operates the facility, etc.

Ask who will be conducting the interview: the recruiter, the nurse manager of a specific unit, a team of managers, will there be multiple interviews occurring in the same day? This information is needed to help prepare for the questions that will be asked as well as planning the time required for the interview process.

Arrive at least 15 minutes ahead of time and dress appropriately. Carry extra copies of the resume and a list of references. Frequently, nursing recruiters will ask for three references, which can be from prior supervisors, unit managers, and/or nursing peers. Other sources can include members of the medical staff, instructors or faculty members, and advisors. Having references prepared prior to the interview is a must. Most applications will include reference information but having references listed separately will make a good impression and assist with remembering all the details. Print these on a separate piece of paper and include names, titles, addresses, and phone numbers. A nice touch is to use the same type of paper and writing style as the resume. Make sure to contact references ahead of time to ask if they are comfortable with giving a positive reference. Tell them who will be conducting the interview so that they are prepared to talk with the recruiter when they call.

During the interview, be aware of body language and tone of voice. Be relaxed and confident and answer questions thoughtfully. If a recruiter asks a question which comes as a surprise, take time to formulate an answer. For example, it would be appropriate to say, "What an interesting question, let me think for a moment." and take a few seconds to organize the answer. Above all, be honest and if it seems that the recruiter is asking for skills that are not in your background, say so - but state a willingness to learn new skills as needed.

After the interview is completed, ask for a timeframe for when a hiring decision will be made and ask if it would be acceptable to call (for example) in a week to check on the job if there has not been any contact by then. If there are many applicants for the same position, it may be some time before the process is completed and this can be nerve wracking. Be persistent but not annoying. Send a thank-you note, either hand written or typed, promptly. This can be another way of making a great impression on the recruiter or nurse manager.

If a position is offered that is not what was expected or what is wanted at this time, then send a letter declining the position as soon as possible with a brief explanation and word of appreciation for the opportunity to have interviewed with their facility. On a similar note, if someone else fills the position, send a thank you along with a note to ask to be considered for future openings at their facility. Remember, if an offer is not made for the job, do not take this personally! Chalk the interview up to experience and move on to the next opportunity. If there have been multiple interviews with as many rejection letters, then seek the advice of a recruiter or career guidance professional to see if there are certain aspects of the career search that could be improved.

Start your job search early, don't wait until a month before graduation.
Look for internships and volunteer positions in your favorite field to add to your resume and assist you with determining areas of interest.
If your paid work experience is sparse, highlight your education and exceptional experiences in your clinical rotations. Employers know that you have had the usual rotations, they are looking for what made you excel on the unit or what makes you different from the other students they are interviewing.
Ask prospective employers about their orientation policies and the availability of a consistent preceptor for your first few months on the job. If hired directly into a specialty unit, make sure there is an extensive orientation period with a dedicated preceptor.
Expand your horizons, be open to employment options outside of your "dream job". Look for openings out of town, in the military, or in volunteer organizations such as the Red Cross or the Peace Corps. You could have a life changing experience, learn new skills, meet fascinating people and have an impressive addition to your resume!
If working in a specialty field is your goal but you are unable to find a facility to hire you into that department right out of school, take another position on a general unit and prepare yourself to move into the specialty when the time is right. Make yourself a prime candidate for the next opening by attending inservices related to that specialty, participate in CEU offerings, or take courses at the community college that will give you an edge on your competition. For example, if working in the OR is your goal, there are classes for surgical technicians and first assistants at certain schools that would be a great investment of time for you while you are waiting for a position to open.

Take some time to deal with the changes in your life and speak to friends, colleagues, or counselors to vent and gain perspective on your situation.
Reorganize your thoughts, review/up-date your resume and look at the opportunities available in your area to determine what you want to do next.
If you have been fired, see what steps you can take to clarify wrongful accusations, errors that were made or misunderstandings before you move on. See if you can get someone to write a positive reference for you, either a co-worker, physician, teacher, or manager.
Be honest but tactful in interviews. Never malign or spread gossip about your last employer, which will only leave a negative impression of you. State briefly why you left and emphasize how eager you are to have a positive experience in a new setting.
For those who have been "downsized", see what compensation packages are available and if the facility is offering to place you in a position somewhere else in their system.
Be proactive in your career. Look at your performance and be sure to position yourself so that you are satisfied, challenged and enjoying your job. If you keep your eyes open to what is happening in your community, facility, and on your unit specifically, you may be able to see changes coming in time to choose your next step instead of your manager choosing it for you!

Take time to assess your priorities and needs and look for new opportunities that reflect these ideals.
Research your options thoroughly. You know the old saying, "The grass is always greener.", many of the frustrations and obstacles you face in your current job are present in other settings as well.
Explore alternative roles in your current facility. Looking for positions on a different unit or department can be a safe way to change jobs without losing seniority or benefits. You are already familiar with the work environment, you have an edge over the competition from the outside, and you probably know nurses who work on the unit and what they think about their roles. Hospitals and healthcare networks have a tremendous range of services and employment opportunities for nurses, possibly ranging from community based settings to tertiary centers, offices, research, teaching, consulting, risk management, informatics, and so on.
Take a class in your field of interest to gain more information and make contacts that might be able to help you in your search.
Network with nurses in your area by attending professional association meetings.
When creating an updated resume, make sure that you write a specific objective for each job you apply for. If you are interviewing for jobs in different clinical areas, make a separate resume for each, re-arranging the information on the resume to highlight the skills needed for each job objective.

For example, if a nurse was applying for two different jobs, one for nursing supervisor and one for the ICU, the information in the (functional style) resume under the skills section, could be the same for both, but the order in which it appears would be different. The objectives would also be specific for each of the separate jobs applied for.

For ICU, the technical nursing skills would be first on the list, with management and/or educational skills to follow. The ICU skills could be elaborated for further emphasis and the management skills condensed to save space.
On the other hand, for a position as supervisor, the management skills would come first, followed by the teaching skills and then the ICU skills. The same holds true with the elaboration of the skills, more in the management section and less in the ICU skills.

If an advanced practice role is your goal, research the employment options for the specific job title in your area.

- Nurse Practitioners are used more and more frequently but in some areas are abundant with little room for new grads, in other areas there is a desperate need.
- Some facilities use Clinical Specialists and certain recruiters feel that the CS role will become popular again with the use of managed care.
- Midwives and CRNAs are other titles that need to be examined in order to know what the job market is like in your region of Pennsylvania.
- The Master of Science in Nursing is a good investment in your nursing career and gives you choices as to what specialty you would like to pursue. Also, nurses who obtain an MBA are highly sought after for their knowledge of business and financial issues, which is needed in today's healthcare environment.
- Give Nursing Research a thought, research is being conducted by advanced nurses in various settings, especially teaching institutions and is giving the nursing profession sound data to back up theories and interventions.

If you are interested in trying one of the ever-growing non-traditional roles being filled by nurses these days, these hints might be of help. Examples of non-traditional roles would be: starting your own business; working for a non-healthcare company as a consultant or educator; marketing a product; free-lance writing, etc.

When writing your resume:

- Be careful not to use technical terms that individuals outside the healthcare setting would not understand.
- Emphasize "transferable skills", meaning skills which are important irregardless of the setting. Such as: teaching individuals or groups; appropriate delegation of tasks to team members; supervision of team members; excellent communication skills; computer proficiency (specifically name programs you are familiar with); ability to work in stressful situations; effective problem solving skills, etc.
- Portfolios can be an extremely useful way of showcasing specific skills, such as artistic abilities and projects, public speaking engagements, writing skills, etc.

When calling for information about job specifics or to set up an interview, ask to speak directly with the person who has the power to hire you. In applying for a job that does not typically utilize nurses, you will have to explain how your background and talents will be a benefit to this position and convince the employer that you have the necessary skills even though you may not have experience in that specific job.
Educate yourself on complimentary skills that nurses may not be strong in such as financial planning, business management, computer technology or technical writing.

The following nursing recruiters, nurse managers and human resource staff members, graciously consented to be interviewed for the purpose of gathering information for this article. I would like to thank them for their time and for giving me the benefit of their experience with nursing recruitment throughout the state of Pennsylvania.

Mr. Scott Tinney, Manager of Employee Relations/Employment
        Robert Packer Hospital - Guthrie, Pennsylvania
Ms. Judy Jim, RN, BSN, MEd Coordinator of Nursing and Healthcare Employment
        UPMC Health System - Pittsburgh, Pennsylvania
Mrs. Pat Patterson, Human Resource Generalist
        Penn State, Geisinger Health System - Danville, Pennsylvania
Ms. Leslie Walters, Nursing Support Manager
        Clarion Hospital - Clarion, Pennsylvania

Sara, a PSNA member, is a nurse living and working in Western PA, who has 15 years experience in Obstetrical nursing and has written PSNA's career articles intended to inform and inspire nurses to learn more about the various employment opportunities within the nursing profession in addition to the traditional roles nurses have been involved in over the years.