Nursing offers more job possibilities than any other aspect of health care. So if your first choice doesn’t work out, select another specialty!
After completing this chapter, you should be able to:
• Assess trends in the job market.
• Identify the primary aspects of obtaining employment.
• Describe the key aspects of an e-portfolio and a resume.
• Describe the essential steps involved in the interviewing process.
• Discuss the typical questions asked by interviewers.
• Analyze your own priorities and needs in a job.
• Develop short-term career goals.
With graduation in sight, you are excited but probably a little anxious about moving into the workplace, looking for the perfect match to your hard-earned degree. As you consider possible employment opportunities, prepare for the upcoming job search as you would any graded class assignment: Do your homework! Careful preparation is the key to finding a job you really want. Very few worthwhile job offers come to someone who just happens to walk into the human resources department. The continued expansion of the health care field and the growing nursing shortage have created tremendous opportunities for recent graduates. You have developed marketable skills that are in demand, but to sell yourself successfully to prospective employers and get the job you really want, you must do some homework.
In addition to evaluating the possibilities and limitations of the job market under consideration, give yourself plenty of time to consider what type of position you want and need, in addition to the possibilities and limitations of the job market under consideration. You can compare the process with the selection of a marriage partner, car, home, or any other major life choice. It is important for nurses to take the time to create a career plan. Your first professional position is a stepping stone in a long nursing career; it will help define who you are and influence your career path. Only you can determine the path you want to travel, so it is important that you become informed and selective in the process. Too often, new graduates accept their first job without sufficient awareness of their own needs or knowledge about the employer they select. Your work is a major factor in your life. If you simply go to work every day, put in your time, and go home, then your job will manage you. If your work enriches your life, is exciting, and you have a feeling of fulfillment, then you are in charge. As a graduate nurse, you have a choice—to do nothing or to take charge of the direction you want to go. However, as the Cheshire Cat was well aware, only Alice could make the choice as to the direction she should go (Fig. 4.1). Although there is no guarantee that a job will be a perfect fit, career dissatisfaction and turnover can be decreased if careful consideration is given to possible job selection before you send out your resume and schedule an interview.
This chapter provides some guidelines to a thorough background preparation for your job search. Critical Thinking Box 4.1 will help you identify your clinical interests and the possible reasons for these preferences. Hint: This will also help you answer interview questions about your professional interests.
What is Happening in the Job Market?
For the past few years it has been impossible to read an article about the health field that does not mention the nursing shortage, the “looming nursing shortage,” or the “worst nursing shortage in U.S. history.” The U.S. nursing shortage is projected to grow to 260,000 registered nurses (RNs) by 2025. Let’s look at a chronological order of current and projected shortage indicators that have been published since Buerhaus et al.’s (2009) statement about the current easing of the nursing shortage due to the recession.
▪ 2010—The Institute of Medicine (IOM) Future of Nursing report called for increasing the number of baccalaureate-prepared nurses in the workforce to 80% and doubling the population of nurses with doctoral degrees. Only 55% of registered nurses are prepared at the baccalaureate or graduate level.
▪ 2012—In the January 2012 issue of American Journal of Medical Quality a group of researchers used projected changes in population size and age to develop demand and supply models to forecast the RN job shortage in each of the 50 states in the publication, “United States Registered Nurse Workforce Report Card and Shortage Forecast.” The number of states with a significant RN shortage ratio will increase from 5 in 2009 to 30 by 2030, for a total national deficit of 918,232 RN jobs. Their findings note a significant RN workforce shortage throughout the country in 2030, with the western states having the largest shortage ratio.
Identify your interests and the possible reasons for them.
| Interests | Reasons |
| 1. I prefer to work with patients whose age is ______________________________. | |
| 2. I prefer to work in a small hospital versus a large medical center _________________________________. | |
| 3. I prefer rotating shifts versus straight shifts _________________________________. | |
| 4. I prefer an internship versus general orientation _________________________________. | |
| 5. I prefer to have a set routine or a constantly changing environment _________________________________. | |
| 6. I prefer these areas (e.g., geriatrics, pediatrics, community, health, medical) ___________________________. | |
| 7. Which of my religious or cultural beliefs or values might have an impact on where I work? _________________________________. |
▪ In the Bureau of Labor Statistics’ Employment Projections 2012–2022 released in December 2013, registered nursing is listed among the top occupations in terms of job growth through 2022. From 2.71 million expected nurse positions in 2012 to 3.24 million needed in 2022, the predicted increase is 19%, or an increase of 526,800 RNs. Approximately 1.05 million nurses will be needed in 2022 to cover the number of job openings for RNs due to growth and replacements (AACN, 2014).
Over the past three decades the Health Resources and Services Administration (HRSA) has reported every 4 years on the supply of RNs through the National Sample Survey of Registered Nurses (NSSRN). Data collection from the most recent, and final, NSSRN was completed in 2008. The 2008 survey noted that the average age of all licensed RNs increased to 47 years in 2008 from 46.8 in 2004, which represents a stabilization after many years of continuing large increases in average age. Nearly 45% of RNs were 50 years of age or older in 2008, a dramatic increase from 33% in 2000 and 25% in 1980 (HRSA, 2010).
In 2015, the National Council of State Boards of Nursing (NCSBN) and the National Forum of State Nursing Workforce Centers worked together to conduct a survey to provide data on the national nursing workforce. The publication is titled The National Council of State Boards of Nursing and the Forum of State Nursing Workforce Centers 2015 National Workforce Survey for RNs (NCSBN, 2015). Their findings include:
▪ Male RNs are a growing minority in the workplace.
▪ Half (50%) of those working in nursing were age 50 or older, which is down from 53% in 2013.
▪ Approximately 19.5% of responding RNs were from a minority population, with newly licensed nurses having a more diverse racial/ethnic composition.
▪ 6.7% of the RN workforce were foreign educated.
▪ 42% of RNs had a BSN or higher degree as their initial credential, while 65% had obtained a baccalaureate or higher degree (in any field) as their highest level of education (NCSBN, 2015).
The graying of the American population will have a large impact on the health care industry. There will continue to be a substantial increase in the number of older patients, and their levels of care will vary widely from assisted living settings to high-technology environments. This impacts the growing need for nurses in the geriatric setting. As the general population is aging, so are nurses.
What will happen with nursing employment, the job market, and health care when a large percentage of nurses become part of the older generation? What effort will hospitals make to retain older nurses as the economic recession recovers? Who will mentor the new nurses and help them develop critical decision-making skills at the bedside? How will the role of simulation help bridge the gap between textbook learning and clinical decision making? According to the Bureau of Labor Statistics 2014-2015 Occupational Outlook Handbook, “Employment of registered nurses is projected to grow 19 percent from 2012 to 2022, faster than the average for all occupations. Growth will occur for a number of reasons, including an increased emphasis on preventative care; growing rates of chronic conditions, such as diabetes and obesity; and demand for healthcare services from the baby boomer population, as they live longer and more active lives.” The current and continuing shortage in nursing personnel in some areas of the country will dramatically heighten the need for increased efficiencies in clinical education for new graduates. How will the job market continue to evolve for the graduate nurse during the next 5 years? Only one thing is certain—everything will continue to change at an increased pace (Critical Thinking Box 4.2).
CRITICAL THINKING BOX 4.2What changes have you observed as a result of the nursing shortage? What impact has the shortage had on salaries and staffing in your community? If the signs of a nursing shortage were beginning to surface as far back as the late 1990s, why haven’t we (education, health care employers, government) created effective solutions to this growing problem yet?
Self-Assessment
What Are My Clinical Interests?
Begin by jotting down possible settings where you could pursue your areas of clinical interest. Depending on your interests, there will be a number of possible paths to pursue. As you identify clinical areas that interest you, try to prioritize them. This step may seem like a nonissue if you tend to “eat, sleep, and drink” one nursing specialty; however, many people have two or more strong interests, and this step helps to outline some increased possibilities. Believe it or not, some graduating students confess to liking every clinical rotation and feel pulled in multiple directions when they consider where to begin a job search. If that description fits you, hang in there—you are not alone! Keep in mind that all nursing experiences, both negative and positive, can contribute to your career in a productive way. The more areas you sample, the broader your knowledge base as you gradually build a career.
Recruiters like to see flexibility in new graduates, but let us try to narrow your professional interests just a bit before your actual job search. Perhaps you can identify what you liked about each clinical rotation through reflective journaling and then prioritize possible interests or identify common experiences.
What Are My Likes and Dislikes?
Another way to approach self-assessment involves identification of your likes and dislikes in the work setting. This is related to interests but on a more personal level. The job you eventually select may have some drawbacks, but it should meet many more of your likes than dislikes in order to be a good “fit” (Fig. 4.2).
Write out your responses to the following questions:
1. Do you enjoy an environment that provides a great deal of patient interaction, or do you thrive in a technically oriented routine? Think back to your clinical rotations and see if you can find a pattern to what was most enjoyable or disagreeable.
▪ I liked opportunities for using many technical skills.
▪ I was bored with slower-paced routines (e.g., mother-infant care).
▪ I liked to see the results of care as soon as possible (e.g., PACU).
▪ I disliked the constant turnover of patients every day (e.g., ED).
2. Do you enjoy caring intensively for one or two patients at a time with a high acuity level and a potential rapid change in patient status, or do you prefer a patient assignment less acute with opportunities for family education and observing increased patient independence? Why did you like or dislike one type or the other? Discuss your responses with some friends who may have had other experiences and get their opinions. Consider how you will explain your preferences to a nurse recruiter on the phone, in an online cover letter, or in person.
3. Do you learn best in a highly structured environment or in more informal on-the-job training situations? Knowing your learning style can guide your interest and narrow your selection of an internship or orientation program. For example, internships range from formal classes with lengthy preceptorships to more informal orientations of fairly short duration. Remember, a program that meets your needs may not be the answer for your best friend. Write down what you would like from an orientation or internship program. Look over your list and prioritize what you need and want most.
4. Do you feel comfortable functioning with a significant degree of autonomy, or do you want and need more direction and supervision at this point in your professional development? Shortly, you will have completed nursing school, backed up by employment on a telemetry unit throughout your senior year. Are you ready to be a charge nurse on the 3 to 11 pm shift in a small rural hospital, or do you want a slower transition to such responsibility? If this situation was offered, would you be flattered, frightened, or flabbergasted? Write down your reaction and consider how you would respond to the recruiter who offers you such a position.
5. How much physical energy are you able and willing to expend at work? Running 8 to 12 hours a day may or may not act as a tonic. Think back to the pace of your clinical rotations, and consider how your body reacted (minus the anxiety associated with instructor supervision, if you can!). Would you prefer a unit that has some predictable periods of frenzy and pause, or do you thrive on the unpredictable for your entire work shift?
6. Are you a day, evening, or night person? Are there certain times of the day when you are at your peak of performance? How about your worst? Be honest and realistic with your answers. Very few people are equally efficient and effective 24 hours a day. If your body shuts down at 10 pm, or you resist all efforts to wake up before 9 am, a certain shift may need to be eliminated. However, if the job market is tight in your area of interest, the available positions may be on a less desirable shift, and you may need to make adjustments in other areas of your life to temporarily acclimate better to a professional position.
7. Do you like rotating shifts, or, perhaps more realistically, can you work rotating shifts? One aspect of reality shock for many new graduates is the realization that working the day shift may have ended with the last clinical rotation in school. Hospital and long-term care staffing is 24 hours a day, 7 days a week. It is a “24/7 profession”—a possibly unpleasant aspect of nursing, but a real one nonetheless. Assess your ability to work certain shifts and try to strike a flexible approach before you speak with nurse recruitment. Working 12-hour shifts (7 am to 7 pm or 7 pm to 7 am) can be very demanding on the days assigned, but this option is very popular with many nurses because of the increased days off.
8. Consider the impact of these choices on your family, your social life, and other needs. If there are certain shifts you must rule out, recognize that this may limit your job choices and plan accordingly. Giving some thought to your flexibility ahead of time will help you avoid committing to any and all shifts during an interview and will facilitate your job hunt. On the other hand, it is probably not realistic to request a Monday-through-Friday schedule in an acute care setting unless the organization has a separate weekend staff or a high level of personnel who request to work only weekends. Shift patterns may vary significantly within a city—and in different areas of the country as well—so do your homework online or through job fairs about available shifts before you go in for an actual interview.
9. Can you work long hours (e.g., 12-hour shifts) without too much tension and fatigue? The 12-hour staffing option offers flexibility (e.g., six 12-hour days of work in an 80-hour pay period) but leaves some people exhausted and irritable. Consider your personal needs outside of work when you respond to this item. Can you climb into bed or put your feet up after a nonstop 12-hour shift, or do you need to pick up family responsibilities as soon as you walk in the door? The 4 days off may well compensate for 3 days of fatigue, but map out your needs before you begin your job search.
10. Do you like making decisions quickly or generally favor a more relaxed approach to clinical problems? In general, ICU and step-down units require more immediate reactions than an adolescent psych unit or orthopedics. Does the ICU environment excite or overwhelm you? Would you prefer a slower pace? Do not criticize yourself for your likes or dislikes. Slower-paced units require different strengths, not less knowledge. You have nothing to gain by working in an ICU if you dislike the setting. Meet your own needs, not someone else’s. You will spend a great deal of your time at work. Make the choice for you, not someone else’s idea of the perfect job.
11. What do you need in a job to be happy? This question does not mean money or benefits but rather the sense that the job is worth getting excited about. Think about past employment you have had, whether in health care or not. What did you like or dislike about the job? What made you stay? Possible answers include opportunities for growth, advancement, working with people you respect, or collegiality. Remember, your answers should include things that are important to you. These are the kinds of issues that make you eager to go to work or to help you work through difficult clinical days. You may want to compare your answers with those of others whose opinions you value to gain a broader perspective.
After thoroughly reflecting on the questions listed, it will be necessary to reflect on yourself as a person and explore what interests you have in the many facets of nursing.
What Are My Personal Needs and Interests?
A third aspect of self-assessment focuses on personal needs and interests. How much time and effort are you willing and able to give to your career at this point in time? Will work be a number-one priority in your life, or does family or continued education take precedence?
Is relocation a possibility? If you are considering relocation, decide how you will gather information on possible job opportunities in the area or areas under consideration. Include Internet websites, professional journals, and professional and family contacts as possible sources of information. In addition to reviewing online job possibilities, research the hospital’s website for details about the organization’s overall philosophy, its department of nursing, and a sense of “fit.” Prospective employers want to know that applicants have taken the time to become knowledgeable about them and appreciate when applicants ask more informed questions about employment.
If this is a voluntary move, develop a list of pros and cons for each location under consideration. Include your personal interests in the decision (e.g., cost of living, commuting time, possible relocation allowance, access to recreational activities, opportunities for advanced education, and clinical opportunities).
What salary range are you willing to consider? Although starting salaries for new graduates are generally nonnegotiable, differentials for evenings, nights, and weekends create a range of salary possibilities. If you want an extended internship, a lower starting salary may be offered. Are you willing and able to trade this for the benefits of an extended internship? The quality of the internship may be worth a lower salary temporarily because of later advancement opportunities. Some areas of the country offer considerably higher salaries than others, but factor in the cost of living before you move out of town. You may be unpleasantly surprised by a monthly rent that swallows up a significant percentage of your salary.
What Are My Career Goals?
The final step of your self-assessment is the development of career goals. Yes, you really do need to have some goals! You are the architect of your professional future, so take pen to paper or fingers to the keyboard and start designing. Consider your answers to the following questions.
What do you want from your first nursing position? Possible answers might include developing confidence in decision making, more proficiency with technical skills, increased organizational abilities, and gathering skills to move into a more favorable position.
What are your professional goals for the first year? Third year? Fifth year? If you cannot imagine your life, let alone your career, beyond 1 to 2 years, relax. Many people feel uneasy planning beyond their initial position and first paid vacation.
Develop a comfortable response to a question regarding your goals for the first year, and consider what you might want to be doing after that time. Remember, it is far easier to gauge how your career is progressing if you have established some benchmark goals to which you can refer. This is also a favorite question posed during interviews, so spend some time thinking about it! Recruiters are interested in nurses with a plan.
Researching Prospective Employers
What Employment Opportunities Are Available?
You have a world of nursing to choose from; there are opportunities available to begin your practice as a graduate nurse. The largest employers are hospitals or acute care facilities. In hospitals, a wide variety of positions are available, although new graduates are almost always placed in staff nurse positions. If it is a general hospital, you need to choose what areas interest you most. Your first position may not be exactly what you want, but remember, it is the first step toward your career goal. As you build your competence and self-esteem, you may find just the position you want. In many hospitals, staff positions represent different levels of proficiency, especially if the hospital participates in clinical or career ladders (Fig. 4.3).
Charge nurse positions may involve responsibility for a particular staff or a particular day, or they may involve managing staff for an entire unit. New graduates should not be placed in charge positions until they have mastered a staff nurse role, but the marketplace may result in new graduates being offered the charge position, especially in more rural settings. If this is a situation that you will face soon after graduation, make sure that you identify your resources and consider whom you can contact for professional support and backup. Do not allow your ego to let you accept an unsafe position that could endanger patients and your hard-earned nursing license.
Entry-level positions in the hospital are usually staff nurse positions. Staff nurse positions in medical-surgical nursing are some of the most demanding—and rewarding—positions. Frequently, nurses begin their careers here with the intention of moving on to greener pastures; however, the rewards and challenges may more than fulfill their needs. It is important that your first position offers you an opportunity to further develop your nursing skills. Surely, you have heard at least one person in nursing school say to you, “You should get a year’s experience in Med-Surg first.” Is this a true statement? Yes and no. Yes, if you want to work in a medical-surgical field, and no, if you do not. Yes, the experience will help sharpen assessment skills and some technical skills, but every area of work has advantages and potential drawbacks. If you know in your heart that med-surg makes you miserable, turn around and go in a different direction. Life is too short to be miserable for 8 to 12 hours a day. Furthermore, chances are that you will not give your best to the patients if you are unhappy.
Whether it is working in the emergency department, day surgery, specialty units, or medical-surgical units, staff nurse positions give you a very valuable opportunity to polish your time management, patient care organization, and nursing skills. Once you are confident with skills, procedures, and the overall practice of nursing, you may be ready to move on to new challenges. This may take 6 months for some recent graduates. For others, it may take a year or more. Take the time to reinforce your nursing competencies; it will prepare you for your future practice in nursing. Other areas in which nurses may find employment include community health, home health care, and nursing agencies. Working in the community in such positions as occupational health, school health, and the military may require a bachelor’s degree in nursing and at least 1 year of hospital nursing. If you want to work in a community setting, concentrate initially on refining your assessment and critical thinking skills in the acute care setting, because the autonomy of the community setting means more decision making on your own without the immediate backup of experienced peers who are usually available in the acute care setting.
What About Advanced Degrees in Nursing?
There are many advantages to earning an advanced degree in nursing (review Chapter 7 for the different choices). One of the most important aspects of obtaining an advanced degree is using your experience as a nurse to help you determine in what direction you want to go. If you have an associate’s degree, you might want to consider the basic requirements for your baccalaureate’s degree, including what schools are available and what their requirements are. This is an area you can begin to work on immediately after graduation. As you interview for jobs, ask whether the prospective employer will work with your schedule if you decide to go back to school and if they provide tuition reimbursement for continuing education.
How Do I Go about Researching Prospective Employers?
Employment Considerations: How Do You Decide on an Employer?
In your search for a job, it is important to look for organizations and hospitals that create a work environment that supports professional nursing practice. In 1980, the American Academy of Nursing identified criteria for the designation of “magnet hospitals.” This designation recognized certain hospitals for their lower turnover rates, their visionary leaders, the value they placed on education, and an ability to maintain open lines of communication. To identify magnet hospitals in your area, check the website http://www.nursecredentialing.org/Magnet/FindaMagnetFacility (ANCC, 2015). Inquire about the last accrediting agency survey results. This may be a state survey in long-term and subacute care or The Joint Commission in acute care. The survey results will give you information about the quality of care delivered at that employment agency. Showing an interest in being a part of a quality organization will convey a positive light as a candidate for hire. In your search for a job, it is important to look for organizations and hospitals that create a work environment that supports professional nursing practice. In the current job market, locating magnet hospitals in your community is an important consideration in your job search.
Media Information
Newspapers
Although many people no longer look at the newspaper for information, preferring the Internet for data, the newspaper is still a good place to access useful information about jobs, as well as articles about hospitals or other health care employment opportunities. This will vary considerably depending on the area of the country where you are hoping to work. Scan the advertisements to see whether any are targeted specifically to graduating seniors. Focus on these initially because they will include information on possible job fairs, internships, or specialized orientations, in addition to specific openings for graduate nurses.
Online searches
Electronic job searches have replaced newspapers for many people as the top place to start looking for employment. This is an efficient way to search because you can access information for both local and distant nursing opportunities with the ease of a few clicks, assuming that sites are kept current. As a new graduate, consider the value of looking at employer websites rather than generic nursing employment sites because employer sites are better focused for new graduates. Additionally, many employer websites offer services for building a profile that allows you to customize based on the department or unit you are interested in working for. It is also a terrific way to review the positions available within the entire organization. If you intend to use this method to follow up on a job posting, be prepared to submit your flawless resume electronically—and be sure to spell-check all of your correspondence before you click the “Send” button! Many organizations now require electronic applications, occasionally raising issues of software compatibility for applicants. Know and be prepared to comply with human resources requirements for submitting your resume and cover letter. Patience in the application process is essential for your professional success. With the availability of computer spell-checking and editing support, there is no excuse for a poorly written resume or cover letter. Take the time to review your documents for errors. Recruiters pay attention to these details.
Social networking
Social networking is the way the 21st century seems to communicate with each other in online websites that consist of a community of individuals with like-minded interests. According to the January 2015 PEW Research Center report, 52% of online adults now use two or more social media sites, a significant increase from 2013, when it stood at 42% of Internet users. For the first time, more than half of all online adults 65 and older (56%) use Facebook, which acts as a social media “home base.” This represents 31% of all seniors. Also for the first time, more than half of Internet using young adults ages 18 to 29 (53%) use Instagram, with almost half of all Instagram users (49%) using the site daily. Internet users with college educations using LinkedIn reached 50%. There is an increase of 23% of online users currently using Twitter. Approximately 36% of Twitter users visit the site daily, but this actually represents a 10-point decrease from the 46% who did so in 2013. About 17% of users visit Pinterest daily, with the majority of them being young women (Duggan et al., 2015).
Thus, if you are trying to make a good impression, then your appearance on the social networking website will be what an employer first sees. Begin by doing an Internet search on yourself and fix anything that may have a negative reflection of yourself. Be sure to use a professional photo, perhaps just a headshot, and make your Facebook account private to prevent employers from searching for you, if you want to use the Facebook account for family and friends. Potential employers may dismiss you as a candidate after viewing inappropriate photographs or information. A study by Careerbuilder (2014) noted that more employers are using networking sites to obtain additional information about a potential applicant. Approximately, 51% of employers who research job applicants on social media said they’ve found content that caused them to eliminate the candidate, up from 43% in 2013 and 34% in 2012.
As the amount of personal information available online grows via sources such as Facebook, Twitter, and the like, first impressions are being formed long before the interview process begins, warns David Opton, ExecuNet CEO and founder. “Given the implications and the shelf-life of Internet content, managing your online image is something everyone should address—regardless of whether or not you’re in a job search,” he says (Lorenz, 2009).
LinkedIn (2015) operates the world’s largest professional network on the Internet with over 400 million members in over 200 countries and territories. LinkedIn has become the place for reconnecting with colleagues and classmates, as well as powering your career with a vast network of contacts and employers looking for the right employee. Recruiters often search this site. If you do not have a profile on LinkedIn, you may be left out of finding the right type of position. LinkedIn® allows you to link to your professional Twitter™, Facebook, or blog pages and upload your resume to your profile, which definitely comes in handy for interested employers.
Job fairs/open houses
You may have the opportunity to attend a nursing job fair or hospital open house as a soon-to-be graduate nurse. Take advantage of these opportunities to collect information about specific employers and possibly make initial contacts for later interviews. Leave your jeans and tennis shoes at home on these occasions, and put on your professional best. Take some time with your appearance, because first impressions are important (Fig. 4.4)!
Employee contacts
If you have a friend or family member—or simply know someone—who works at an organization you are considering for employment, make an effort to speak with him or her about the job environment. As an insider, this person may be able to provide you with a perspective about the employer that the advertisement, recruiter, or interview cannot. Possible questions you may want to ask such an insider may include these: “Why do you enjoy working there? What was orientation like? How is employee morale? What is the turnover rate for nursing or for other employees? Does management show appreciation for employee effort and welcome employee input?”
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