Yes, You Can Have It All

Yes, You Can Have It All

You can have it all. Decrease the stress in your life. Stop to smell the roses. Be in the moment. Great words of advice, but how does that happen? I don’t know about you, but I have found it almost impossible to accomplish! Almost.

I am the manager of a group of neonatal nurse practitioners in a level 3+ NICU of a large, urban Midwestern university hospital that provides care to an underserved population.  Yikes! Talk about stressors.

There are 18 women all ages, experiences, and personalities in our group. The question is: How do you create a cohesive, compassionate, supportive, and clinically excellent group of practitioners? Well, it took years of trial and error, strong faculty support, and the unexpected loss of our previous beloved manager—and then to find our feet again over the next three years. I hate it when people say “it’s a process.” Really? Of course it is, but it’s hard to see it in the beginning. We all want instant gratification, whether it’s from new sources, TV, retail, or work. I want it NOW! Yeah, well, that’s not going to happen.

First, you must have individuals of amazing talent, drive, personality, and intelligence. No short order for anyone. I’m not sure how we achieved this dynamic, but we did. Every person in our group is unique in their interests and skills. We foster and encourage the differences. We celebrate the differences. Thank goodness there are NNPs that are the ultimate in PICC insertion skills—not me! I will do anything for you if you get my line in—I will see all the other babies! (Just a note, my other procedural skills are awesome.) Thank goodness we have some young energetic women that love to go on transport. I am getting too old for climbing in and out of ambulances. [et_bloom_inline optin_id=optin_52]

Second, you must have the unwavering support of the faculty of neonatologists. Without the clear dedication of the physicians it’s like fighting upstream in the spring run off.  I’m not talking about money or time off or even the gift at Christmas. I’m talking about standing for you and beside you to the bureaucracy of administration. We all face shortages of staff, long hours, and extremely difficult patient care situations, but when you know that the medical staff is with you—and you with them—it means everything.

Third, and most important, you need to see the problems that cause discord, anxiety, and anger within the group. In my first ten years here, the NNP group was growing in numbers and responsibilities, especially when we moved into our new, larger NICU. Often when a need arose in the unit the response was ”the practitioners can do it.” Sound familiar? Five years ago we unexpectedly lost our manager. This was a stunning blow to our group and unit. The next two and half years were a struggle as the section and department leadership changed, thus leaving the NNPs in limbo for their own leadership. In many ways the group was rudderless. We had no goal or focus. We reacted to the needs of the unit without any professional growth for any of us.

Last, you must have a manager/leader who believes. Believes in themselves, the members of the group, the faculty, the staff nurses, and staff support members. I know it sounds hokey, but it is absolutely essential. When I became the manager, I held a dinner at my home so we could come together as individuals to talk, laugh, cry, and plan.  I met with every practitioner to discuss their goals, aspirations, and what they wanted from me as the manager. Since we cover the unit 24/7/365, the NNPs are never all together at an event. I insisted that the NNP group have an annual retreat so that we could all be together to continue the discussion for our group. With a facilitator, we identified several issues that had been troubling us for many months. We designed a plan to address these issues. We also affirmed our commitment to each other as colleagues and friends.

We continue the “process” to grow and change. But it is not all the big stuff, the retreats and meetings. It is the seemingly small things, like making our collective office a little more cozy, posting funny and inspiring quotes, putting a seasonal wreath on the office door for all to enjoy, and remembering that this is our job, not our life. We are not always perfect, but we strive to be. You can have it all — just not all the time.

 

 

6 Tips for Beating Burnout

6 Tips for Beating Burnout

Do you feel exhausted, anxious, or dread the thought of going to work each day? In last month’s article, we discussed these subtle signs (and more) which indicate your body may be headed for burnout. Already feeling burned out? Let’s look at some steps you can take to overcome this chronic, stressful state and begin thriving again.

1. Identify the source of the stress.

The Mayo Clinic offers this tip for pinpointing the circumstances that are causing you to feel overwhelmed: “Once you’ve identified what’s fueling your feelings of job burnout, you can make a plan to address the issues.” If you have trouble recognizing the cause, try tracking your job responsibilities for a few days, and write down how you feel after you’ve done each activity. Tracking your feelings will help you concentrate your efforts on the areas that are truly quelling your passion for nursing.

2. Minimize your time with these stressors.

Harvard Business Review (HBR) suggests you may need to consider reducing your workload or taking a vacation as ways to recover from burnout. HBR also recommends limiting your interaction with people who leave you feeling drained and delegating the tasks that don’t require your personal touch to other people. Furthermore, they advise to disconnect from your work when you finish your shift and on your days off. Bottom line: Don’t take your work home with you. What happens at the hospital (or another facility), stays at the hospital.

3. Find a support network.

Perhaps you have supportive colleagues, friends, or family members who can help you through this challenging time. However, for some nurses, the level of burnout requires the assistance of a professional. Try not to view your quest for help as a sign of weakness, but rather, a bold step forward toward creating the life and the working environment you want. Additionally, many employers will offer an Employee Assistance Program to help you resolve personal and work-related problems. Take advantage of whatever services are available to you.

4. Practice self-care.

An article from Sanford Brown College makes this observation regarding workplace burnout in nurses, “Even the strongest nurse who puts too much devotion into her work faces the risk of ‘compassion fatigue.’” It’s easy to get caught up in taking care of others and neglecting your needs. But cultivating a balance between work and your personal activities will go a long way in helping you heal from burnout. Sanford Brown offers these pearls of wisdom for struggling nurses:

“Good self-care for nurses includes eating well, getting enough sleep, avoiding harmful substances and staying physically active. You may be on your feet all day at work, but the rest of your body needs a different kind of workout. Maintaining strong mental and spiritual health (if appropriate) is also essential. Whether it is meditation, yoga or prayer, set aside a part of the day to find a calming moment that belongs only to you.”

5. Find a creative outlet.

When you’re in a state of burnout, you’re more prone to making mistakes, losing focus, and feeling unhappy. Research suggests creative endeavors can enhance your mood, increase your energy, boost your immune system, lower stress levels, and provide a positive distraction from the things that are weighing you down. Been itching to try a writing class? Maybe you’ve been eyeing a community pottery class for several months. Now, is the perfect time to tap into your creative side and reconnect with the joy and wonder of life.

6. Consider your options.

Have an honest talk with yourself. If you’ve tried the above tips to no avail, it might be time for you to consider a job change. While it’s not an easy decision to make, you may find you’re more fulfilled in a less demanding job that supports your values and beliefs.

From the ER to the ICU: One Nurse’s Experience

From the ER to the ICU: One Nurse’s Experience

Below, I interview Erin Sullivan, BSN, RN, CEN, about her experiences in critical care. She recently switched her specialty from the emergency nursing to intensive care, and shares her reflections, challenges, and some advice.

What is your background in nursing?

I graduated as a second degree nursing student from George Washington University in 2014. I was a new graduate nurse in the emergency department (ED) for about two years before I switched to the MICU (medical intensive care unit) in March 2016.

When did you decide to change specialty, and why?

I decided to switch to the ICU about 18 months into working in the ED. At the time, I was considering applying to some graduate school programs that required ICU experience as a prerequisite, so I made the switch to broaden my experience and learn a new skill set. 

What do you do now and what is your job/where?

I’m working in the MICU at Northwestern Memorial Hospital in Chicago. I also still work per diem in an ED.

What was challenging about the transition to the ICU?

The biggest challenge I had in transitioning from emergency nursing to the ICU was learning how to think like an ICU nurse. There are jokes in nursing that the two types of nurses are “wired differently.” In the ED, the goal is to quickly assess, diagnose, and stabilize patients, and then to move them out to an appropriate level of care as soon as possible. In the ICU, the goals for the patient are more long term, and you have to consider a bigger picture and a larger scope than I would in the ED. It’s a completely different way of thinking, organizing, and prioritizing patient care.

What do you miss most from ER nursing?

The thing I miss most about the ED is the teamwork. I don’t know that I can quite explain the team aspect of ER nursing to someone who’s never experienced it, but there is a special camaraderie that forms between all of your coworkers. Whether it’s one of the best shifts or the worst shift ever, your fellow coworkers join together to make sure we all come out on the other side. I also miss the organized chaos that is the ED, and the anticipation of never knowing what is coming through the door next.

What do you enjoy most about the ICU?

Being in the ICU, I really enjoy being able to watch a patient progress from being critically ill to becoming well enough to leave the unit. Unlike the ED, many times you have a patient three or four shifts in a row, so you can get to know the patients in a way I never got to in the ED.

What do you want to do with your nursing career moving forward?

I’m not sure what the next step is in my career. One of the reasons I chose nursing was because there are so many different options in what you can do. For now, I’m enjoying working in the MICU and picking up in the ED every now and again to get my adrenaline fix. I’m fairly certain though that I’ll find myself back in school pursuing a graduate degree in nursing at some point. 

What tips or advice do you have for someone who wants to change their specialty?

My biggest advice for anyone considering switching their specialty is just to do it. As nurses we learn new things everyday, and we shouldn’t be intimidated or scared of the challenges that come with switching specialties!

That said, do your research. Can you handle the stress of a new job right now? Are you adaptable and a quick learner? Do you get along well with new people? These are all considerations before jumping into a new specialty. For me, I was still within the broader scope of critical care. If you’re completely changing specialties, from adults to pediatrics, or from med-surg to labor and delivery, make sure you talk to people who are in that field and that it seems like the right fit for you. But remember, you can always go back!

Nurses Storm the U.S. Capitol to Demand Safe Staffing Ratios

Nurses Storm the U.S. Capitol to Demand Safe Staffing Ratios

“You are so overburdened. The situation has made it impossible to give the care you need to. We need more of you. We need much better staffing ratios. It’s really that simple.” –Congresswoman Jan Schakowsky (D-Illinois ), author of Nursing Staffing Standards for Patient Safety and Quality Care Act (HR 1602), in a speech on Capitol Hill at the Nurses Take DC Rally

It had rained in Washington, D.C., for 15 straight days, but on May 12, 2016, the weather held off. Nurses from all over the country gathered under cloudy skies and congregated around a simple speaker stand with flags to either side stating, “Safe Nursing Ratios Save Lives.”

The ground was boggy, causing many nurses to sink into the mud, but none could turn their eyes away from the Capitol building that hung over the scene, a reminder of the power of the people. On this misty, humid, and rain-free day, nurses made their demands for safer staffing ratios known with the smell of wet grass in their noses and a cheer in their throats for the thoughts so passionately and aptly expressed by the many speakers.

The speakers roused the crowd with inspired words, and nurses held up signs in support of the legislation. They shared heartfelt stories of nurses and patients who have suffered poor ratios on the front lines. What happened on this slate gray day in front of the great building of government? Promises of safe ratios, belief in the power of legislation, and a comradery that transcended specialty, geography, and years of service rang out from Congresswomen and nurses alike.

Why Ratios?

Of all of the problems nursing has—bullying, burnout, and nurses leaving the profession—why are all of these people focusing on ratios? It is because ratios affect patient safety the most, and nurses are always focused on patient safety first.

Janie Harvey Garner, RN, founder and executive director of Show Me Your Stethoscope, was asked why she chose this issue for her group. “Because I have been that nurse with the third patient in the ICU,” she says. “I’ve been the nurse with the nine patients on med/surg. It’s not safe for anybody, and quite honestly, though I am extremely concerned about hurting a patient, I’m also very concerned about hurting a nurse because second victim syndrome is a super health issue, for me anyway. I don’t think it is with hospital organizations, but it sure is with me. Kim Hyatt died. Let’s not make it in vain.” (Hyatt committed suicide after making a medication error, which may or may not have been related to staffing issues.)

Rebecca Love, BA, MSN, RN, ANP, regional director for the North East region of Show Me Your Stethoscope and founder of HireNurses.com, went even further when she stated, “I think what we’re seeing in the hospital is verging on the level of we are choosing which patients are going to live and which patients are going to die every day when we come in and deal with the ratios that we are dealing with.”

In fact, Kelsey Rowell, RN, thinks that staffing ratios may be leading to some of the other problems that face nurses. “I think we’re spread so thin that it’s really causing nurses to experience compassion fatigue and feel tired. I think ratios are something that’s going to be ultimately good in a long haul.”

Ratios are the most important issue in nursing because it is about the patients. There is no way to get around that fact, and that is why this legislation is so important. Nurses need to stand up and be heard. People can and will die when nurses are spread too thin, and that not only hurts patients, but it severely impacts the psychology of the nurse.

The general public doesn’t even know this is an issue because they don’t know what nurses do. “Nurses need to speak about the value of their work,” says Sandy Summers, RN, MSN, MPH, founder and executive director of The Truth About Nursing, and coauthor of Saving Lives: Why the Media’s Portrayal of Nursing Puts Us All at Risk. “Moving their heads up high and saying, ‘I can’t possibly take care of four ICU patients, someone is going to die. I can barely take care of two.’ So working on safe staffing issues is ultimately joining our mission of working to educate the public about the value of nursing, the work that nurses do to save lives.”

The Legislation

The hubbub at the Capitol was due to the legislation that is now in the House of Representatives called HR 1602. There is also a Senate bill for nurse to patient ratios, but it is still in its very beginning stages. Like the California laws, this bill calls for mandatory ratios across the country. Here is what the bill proposes hospitals will have to offer nurses who work for them:

“[A] hospital’s staffing plan shall provide that, at all times during each shift within a unit of the hospital, a direct care registered nurse may be assigned to not more than the following number of patients in that unit:

  • One patient in trauma emergency units.
  • One patient in operating room units, provided that a minimum of 1 additional person serves as a scrub assistant in such unit.
  • Two patients in critical care units, including neonatal intensive care units, emergency critical care and intensive care units, labor and delivery units, coronary care units, acute respiratory care units, postanesthesia units, and burn units.
  • Three patients in emergency room units, pediatrics units, stepdown units, telemetry units, antepartum units, and combined labor, deliver, and postpartum units.
  • Four patients in medical-surgical units, intermediate care nursery units, acute care psychiatric units, and other specialty care units.
  • Five patients in rehabilitation units and skilled nursing units.
  • Six patients in postpartum (3 couplets) units and well-baby nursery units.”
Congresswoman Jan Schakowsky

Nurses posing with Congresswoman Jan Schakowsky

This bill was proposed by Congresswoman Jan Schakowsky (D-Illinois), a woman of great charisma and passion for nurses and ratios alike. She is moved by health care and the plight of nurses everywhere. “If we really want to improve patient care, we have to improve the nurse staffing ratio,” says Congresswoman Schakowsky. “There’s just no question about it. It is nurses that are on the frontlines. If they have too many patients, then nurses just can’t do the job that we need done.”

In the House, different representatives can agree to co-sponsor a bill, or lend their support to its cause. Two of those representatives are Congresswoman Donna F. Edwards (D-Maryland) and Congresswoman Joyce Beatty (D-Ohio), and both are passionate about the cause.

After a rousing speech to the nurses assembled, Congresswoman Beatty spoke with similar eloquence as to why she supports the bill: “It makes a difference in the lives of not only nurses but in the lives of patients. It’s good for patients. It’s good for health care. I want to say thank you for being out here because getting a bill passed and moving it along the way is standing up for what you believe in. I can go back to the house floor and I can say I believe in nurses.”

Congresswoman Edwards was similarly supportive of the bill and of nurses. “We want to make sure that our patients and our nurses are operating in the kind of environment that allows them to provide quality health care,” she explains. “That quality is jeopardized when nurses have so many patients to care for when they have some other responsibilities that don’t involve direct patient care.”

Nurses and Health Care

It’s great to talk about getting more nursing at the bedside, but nurses cost money. With the rising cost of health care, it may not be feasible to expect that the system could support better nurse ratios. The Affordable Care Act aims to get more people health insurance, but how does this impact nurses? More patients mean more work, higher ratios, and more stress. What is the solution?

Congresswoman Donna F. Edwards

Nurse talking to Congresswoman Donna F. Edwards

Congresswoman Edwards doesn’t see this as a problem: “It’s really clear that even under the Affordable Care Act, we’ve always known that we’re going to be in an environment where we need more nurses, more qualified care in medical settings, and that’s going to be really important with so many more people coming in to the system requiring care that staffing ratios are [an] important component of that kind of quality care.”

Obviously, this will need to be addressed if more patients are coming into the system. If there are no ratios in place, this could lead to very unsafe staffing in most facilities. That makes it even more important to pass this legislation . . . and to find ways to get more nurses to the bedside.

Congresswomen Schakowsky also wants more nurses: “We need to make sure that health care providers are also increased to make sure that we can actually deliver the care to these millions more people.”

“We’re trying to marry the two of the insurance and having good medical services,” says Congresswoman Beatty. “I don’t see them on separate ends. You can’t be for health care and be against good nursing. You can’t be for good nursing and be against health care.”

Despite the positive talk, the increase in patients will trickle down to nurses. This legislation needs to pass so that the facilities can’t just continue to add to the nurse workload because there are more patients than they know what to do with.

Ways to Improve Ratios

Ratios are obviously a problem, but legislation cannot possibly be the only solution. For starters, there are some flaws in the bill proposed, but laws can take a very long time to come into effect. Patients are dying now. Nurses are suffering now. There has to be something else nurses can do to impact this issue.

Rowell has a few ideas. “I think it’s going to start with awareness,” she says. “Maybe it’s going to be starting with people standing out and voicing everything going on and the severity of it. If we continue to let the business of the profession run what we do, we will focus on profit over patients’ safety, and that is a big deal.”

There are other factors that stand in the way, as well. Love points out that “I think that there are powerful interests at play that oppose this kind of change. Largely insurance and health care and hospital administrators because nursing costs money and the only way that we’re going to be able to fight that is when we state we will have mandated safe staffing levels.”

It is certainly true that insurance isn’t going to support staffing ratios. The more they keep costs down, the better. Unfortunately, this often comes at the expense of patients and nurses. With the Affordable Care Act, insurance companies will look to cut costs even more, and that is a dangerous precedent for the movement.

It is also true that facilities don’t tend to listen to nurses. They are seen as complainers, but even then, nurses can find a way to maneuver themselves into a better situation. “We have to encourage patients and their families, and caregivers to start questioning a lot more,” says Andrew Lopez, RN, president and CEO of Nursefriendly.com. “We have to feed them the information they need. Social media is an excellent vehicle. We can do that. Social media gives us a platform where we can go on to Facebook, we can go on to Twitter, and go on to communities where we will be welcomed as nurses, as ambassadors of health.”

Deficiencies to the Bills

One of the problems with the bill is that it doesn’t provide for an acuity scale. Although it is mentioned, a scale is not specifically written out. This can leave the door open for facilities to exploit it by giving nurses the required number of patients but swamping them with patients requiring a great deal of care.

“We want the hospitals to be working with the nurses to figure out exactly what number needs to be there,” says Congresswoman Schakowsky. “Obviously, when there’s greater acuity, we need to have even more nurses that are available. It’s clearly a big factor. We haven’t put a number in the bill but we want that taken into clear account.” However, leaving the negotiation to the hospitals may not be the best idea.

Congresswoman Beatty agreed and showed a remarkable knowledge of what nurses experience every day. “I think that’s one of the things we’re going to work through. Certainly when you know if a patient is sicker than another patient, they require more care. If you’re in intensive care or if you get an infection, the requirements are that it takes more work.”

Another glaring oversight of the bill is the lack of ratios for those in long term care and rehabilitation. In these specialties, registered nurses can have up to 40 patients with minimal support staff under them.

Summers stated that this was one problem with the bill that needed to be addressed. “A nurse told me in her rehab center, there are two nurses for every 17 ventilated patients. That is so reckless. But taking care of ventilated patients is hard.  Their tubes always get blocked up. They get secretions and coughing. Eight and a half patients each? That’s reckless. She thought that wasn’t as bad as they have on the floor which is 40 patients each or 50, I think.”

Clearly, this is a problem, and it needs to be addressed in the bill. It is an oversight that has caused many to withdraw their support. For this reason and others, national groups like the American Nurses Association are not as supportive. “The ANA is not supportive of the current legislation, but that does not necessarily mean that they’re not supportive of us,” explains Garner. “I think they’re in general supportive of a grass root effort, but they certainly do not back the current legislation that we’re supporting.”

The Future

Although there are some flaws with the bill, the future may rely on its passing. This is why nurses support it—it is the best thing out there for the problems they face. What is the future of nursing and this bill?

Caroline Thomas from EmpowerRN states, “I think you know the future of nursing is very bright obviously. Statistically, we have a huge gap in the amount of nurses that we have and the amount of nurses that we’re going to need in the future. Having a degree in nursing, it opens up a lot of doors other than just the traditional. I definitely recommend it; I think it’s a great time to get in to it.” Despite the flaws, nursing still remains a profession that is worthy of pursuit.

Love has a completely different take on the future of nursing and of ratios: “I believe what’s going on, is that we are becoming so overburdened with the amount of patients that we are caring for that it is driving down the quality of care. It’s forcing nurses out of the profession and eventually we are going to end up with nobody by the bedside to care for patients. I think the future of nursing and the future of health care are at risk.”

Where is Show Me Your Stethoscope going from here? Garner is optimistic. “We’re going to continue to do nurse advocacy. We’ll also continue to do patient advocacy. Mostly, I see us doing what nurses want us to do because we’re a nurse’s organization. I don’t want to unionize the world. All we want to do is do what nurses want to do.”

In the end, nurses are fighting for their patients and themselves when everyone else doesn’t understand the struggle or even knows it exists. Advocacy for nurses is needed. Education of the public is also necessary. Legislation is only one road. Starting a dialogue and standing up for nurses is the way to lasting change. This is the future of the staffing ratio debate, and with this rally, nurses are off to a great start.

But it is only the start.

The Nurse Recruiter and You

The Nurse Recruiter and You

When Brittany Castaneda-Thibault, BSN, RN, first started her job search she made sure that the first thing she mentioned in her resume and cover letter was her externship at the Mayo Clinic in Rochester, Minnesota. She wanted recruiters and hiring managers alike to recognize that she had experience, albeit for one summer, in surgical nursing.

Castaneda-Thibault’s strategy worked. Before she even graduated from her University of Texas-Austin nursing program, she had snared a job as a cardiac surgical nurse at Baylor Scott & White Health in Round Rock, Texas.

“Yes, grades are important, especially if you want to go back to school,” says Castaneda-Thibault. “But you need to show everyone who’s reading your resume that you’re familiar with patient-centered care because you’ve worked in it. You have experience.” [et_bloom_inline optin_id=optin_18]

Indeed, in terms of getting noticed by a recruiter, what you do outside the classroom may be just as important as what you achieve inside. Granted, you’ll have to demonstrate that you know your academic and clinical stuff to be considered a quality candidate and potentially valued member of the nursing staff. But hiring professionals have their eagle eyes focused on a mix of factors. They want to see a well-rounded individual who’s not only prepared, but also professional and passionate.

As Ellen Lorenz, nursing talent acquisitions specialist for the North Shore Long Island Jewish Health System, says: “It’s not that they just went to school. It’s that they did other things as well. They made the most of their time as students.”

Be Prepared

Your recruiter will be measuring you against other applicants, so it’s important to be savvy in how you present yourself. You want to pull together all of the resources that could propel you into the job of your dreams—or at least one that’s a satisfying start to a nursing career. That means not only highlighting your achievements, but also demonstrating your knowledge of the institution’s strengths. Since every interview is a two-way conversation, the recruiter likely will expect you to have your fair share of questions. (Now is the time to bone up on the organization’s website.)

Castaneda-Thibault, for example, not only took advantage of her program’s leadership class to master everything she could about the job hunting process, but she also tapped the websites of each organization that granted an interview to learn more about the mission, surgical specialties, and even nursing models. “All of the questions that I couldn’t find answers for I wrote down and asked during the interview,” she says. “It was helpful in helping me look very interested in the hospital and what they did.”

When the spotlight shifts to you, your goal is to make everything you’ve done relevant to the job. Hopefully, your resume is a well-organized mix of academic achievements and other activities. How important is your GPA? It’s as relevant to your job search as a potential employer makes it. If your record puts you at the top of the class, highlight it. In fact, some organizations will be delighted to court you because they want the highest achievers.

Yet more often than not, recruiters are targeting the bigger educational picture in evaluating scholastic success. They’re interested in the content of your classes, the focus of your clinicals, and even the experience you gained from a practicum, externship, or volunteer or part-time job.

At Washington, DC-based Children’s National Health System, for instance, the emphasis is always on a broader evaluation than just one’s GPA. “We’re looking at the whole person, and your academic record is certainly not the whole person,” says Jill Board, MS, BSN, RN, a nurse recruiter, noting that whatever applicants did through their high school or college years involving children—teaching dance, babysitting a family, or even volunteering for a youth group—are profile-raising. “It jumps out at us if we see that you weren’t building a resume just to build a resume, but you really enjoy working with children. That’s important.”

Likewise, although Castaneda-Thibault’s GPA hovered at 3.5-3.6 during nursing school, she didn’t think it was her strongest suit. So she highlighted the points—her leadership roles, volunteer activities, and part-time work in addition to the externship—that demonstrated she was both well-rounded and prepared. She also kept her eye on the ball by applying only for those specialties—surgery, pediatrics, or critical care—that she really wanted. Admittedly, by targeting areas that are normally difficult for first-year grads, Castaneda-Thibault had fewer calls than her colleagues. Yet by parlaying her experience, particularly her Mayo Clinic training, she made a positive enough impression on managers to achieve her ultimate goal.

Be Professional

When it comes to putting your best foot forward, remember that etiquette counts. No matter how high your GPA is, it won’t matter if you don’t combine your academic achievements with common and business sense. “I can’t say enough about how you only have a few minutes to make a good impression,” says Lorenz. “It’s very important that you look put together—that you present a professional package.”

But it’s more than just dressing the part, even though what you wear signals that you’re either a serious candidate or not up to the task. (Bring out the suit!) Recruiters are attuned to factors you might overlook. The tone of your e-mail, the sound of your voicemail, and the way you behave during an interview, for instance, all resonate.

It’s fine to be a “happy warrior” or “hot babe” to your e-mail friends, but during your job search, you need to have a grown-up e-mail address. Likewise, your voicemail’s snappy intro—“Yo, the phone is here but I’m not. Leave your info.”—may fit you to a T personally, but when recruiters call, they want to hear: “You have reached Jo(e). I’m sorry I’m not here to take your call, but please leave a number and I will get back to you as soon as I return.”

As to interviews, at the top of the red flag and pet peeve list for many hiring pros are candidates who arrive late and don’t apologize for their tardiness. So whether you’re scheduled to talk on the phone or meet in person, be on time and on guard. It’s not only important to deftly navigate the formal interview, but don’t drop your defenses if you’re asked to shadow on the unit since you’re being evaluated there too!

For instance, as the market leader for Milwaukee, WI-based Medical Staffing Network & Allied Health Group, Susie Clementi has one goal in mind: Establishing a rapport with her nursing applicants so she knows more about them than their five-year plans. The downside, however, is that sometimes candidates get too comfortable. “They drop the professional façade to reveal who they actually are,” Clementi says. “That might not have been enough to lose the job, but it could be enough to lose the opportunity to interview further for it.”

Be Passionate

No matter how polished and impressive your resume, you’ll need to show recruiters more than academic qualifications for the job. From your cover letter to your interview, you want to demonstrate that you’re truly engaged in the specialty, are excited about the position, and have decided that this is the place you want to be. That’s not to say that you’re not open to possibilities. Even recruiters understand that you may have liked so many aspects of nursing school that you’re unsure about your career path, but don’t appear so anxious that you’re seemingly throwing darts at a board.

“If you come across like you’re willing to take anything because you just want a job, you’re not the kind of candidate we’re really looking for,” explains Lorenz. “We want people who are excited and passionate in what they’ll be doing. It’s not about taking any job. It’s about taking the right job . . .and having the right candidate for the job.”

Board agrees, noting that a cover letter is the first opportunity to cement your commitment in the mind of a recruiter. You do it by producing a letter that’s not just generic in its appeal but refers specifically to the job at hand and qualifications or interests you have for it. “I often tell people I’m only half joking when I say, ‘If you can make me cry, you probably will get an interview,’” she says. “Nursing is hard work and we want to see if someone is committed and feels that this is really what they’re meant to do.”

Case in point: Board recalls giving one aspiring applicant a second look after the woman called and asked what she could have done differently to land an interview. When Board suggested that she needed to offer more than just “the dry basics” in her resume and cover letter to gain a foothold, the caller mentioned how her experience as the mother of a sick child had inspired her.

Granted, that kind of information may not be appropriate for every position—you have to be measured in how you use any personal narrative. Yet as a former manager who had hired parents of children treated at her institution, Board saw the story as ripe for an effective cover letter since it showed her commitment to pediatric care. When the caller resubmitted the application and letter with reference to her story, Board was happy to schedule an interview. She won the job!

Final Thoughts

Searching for a nursing job can definitely create stress. Finding the right position takes time, energy, and emotion. But by knowing what recruiters might have on their agendas, you not only can reduce the levels, but also increase your profile as a standout candidate.