Getting to Yes: The Art of Negotiation for Nurses

Getting to Yes: The Art of Negotiation for Nurses

One of the American Nurses Association’s seven Bill of Rights for Registered Nurses is to “freely and openly advocate for themselves and their patients.” Yet, women and minorities may not be as effective advocating because they’re less likely to negotiate. There is a “win-win” negotiating style, developed at Harvard’s famed Negotiation Project, which may be more appealing. Practice them in small ways until they become second nature. Then when it’s necessary to advocate about safety, staffing, workplace violence, etc., you will be ready with a collaborative, problem-solving approach.

But if you don’t negotiate? Nurses who accept poor ­compensation or working conditions can end up feeling victimized, devalued, and unmotivated. With that attitude, they are less likely to provide excellent patient care and to get promotions. Don’t let that happen to you. Elevating your negotiation skills will lead to better communication, collaboration, and results for you and every other party.

negotiation phrasesReframe the Concept of Negotiations

Given the overwhelming percentage of female nurses, it’s important to consider how gender plays into negotiation. Research shows that women are two and a half times more apprehensive about negotiating, while men are four times more likely to initiate a negotiation. In fact, 20% of women say they don’t ever negotiate, even when the situation necessitates it, according to Linda Babcock and Sara Laschever, authors of Women Don’t Ask: Negotiation and the Gender ­Divide.

That apprehension keeps many nurses from learning and practicing this important communication competency. “Negotiation is in the top five life skills that everyone should have,” insists Donna ­Cardillo, RN, author of The Ultimate ­Career Guide for Nurses.
“We negotiate all the time—with our kids, ­partners, ­patients, and coworkers, often without even realizing it. The word can have a negative connotation but only because most people don’t understand what it really is,” explains Cardillo. In health care, there is an additional connotation, and that’s terms of negotiation and union contracts, she adds.

According to Webster’s Dictionary, “negotiation” is defined as “to meet and discuss with another in order to reach an agreement.” But many of us suspect that in order to do that, one party must dominate, trick, or pressure the other into submission.

Sometimes, we have to reframe an uncomfortable concept, like negotiation, and perceive it in a new way, to make it more palatable, notes Cardillo.

“For example, say a nurse wants to attend a national nursing conference, and get paid time off, and expenses covered and so on. I’ll advise explaining the benefit to the hospital and the nurse manager. ‘By going, I’ll be able to bring back information from national speakers and experts to share. I will do an in-service session, or write a paper on it, and I’ll bring back printed materials,’” she explains. Nurses needn’t let a “No” response discourage them, either, adds Cardillo, because it may take repeated requests to get what you want. But if you don’t ask, the answer is always “No.”

Another way to reframe it, Cardillo says, is that by asking you’re planting seeds of change for the future, so you’re advocating for yourself and for your profession.

“Many of us were raised not to ask for what we want and to feel satisfied with whatever we got. I just saw a tweet from a nurse: ‘People say I need this job. I say this job needs me.’ That’s so true. Everyone is entitled to feel valued in the workplace,” she says.

Steven P. Cohen, author of The Practical ­Negotiator, has trained health care ­professionals in negotiation skills globally and agrees that nurses must self-advocate. “Your number one job is to look out for your own interests. Self-interest means maximizing circumstances to help you get what you need: good pay and benefits, rewards and resources that let you serve the patient. You must be well served.” He notes that if a nurse is treated badly, then he or she can’t function well, and patients suffer.

There are three kinds of interests to consider and prioritize in a negotiation—in conflict, complementary, or in common, according to Cohen. “If you’re going on vacation with a multigenerational family, how likely is it that you have common interests and all want to do the same things? Not likely. But you may have complementary interests. Your goal could be that everyone in the family will have a good time on the vacation.” He advises nurses to look for where there are complementary interests and no conflict, and to build step-by-step to a win-win solution. “Most anyone in a hospital, from aide to CEO, has similar objectives,” he adds “and is asking the same questions: How can I make the most of my job? How can I take care of the people I need to take care of?”

Negotiate in Your Off-Hours

One of the best ways for nurses to become empowered is for them to learn and ­practice good negotiation skills, asserts Michelle Podlesni, RN, president of the National Nurses in Business Association. “Why are we having nurses that don’t last two years in a hospital setting? Because they aren’t empowered and negotiation starts with assuming your power. I help nurses to understand their power,” she explains.

Podlesni believes that negotiation skills can be learned, like other important nursing skills. Earlier in her career she read The Power of Nice by Ronald Shapiro and Mark Jankowski, and it made a big impression on her. The book defines negotiation as using knowledge to get what you want, using the “three P’s” of preparing, probing, and proposing.

“Say a new nurse is getting scheduled in a certain way. How do they know it’s fair? You ask: ‘How is the schedule made?’ Nurses don’t always assess their own situation and propose what works better for them. We need to make a paradigm shift—your license is a license to start practicing in your business as a nurse,” Podlesni says.

Think of your negotiation skills as a muscle and flex it often in everyday situations. “Practice everywhere you go, even at the Macy’s makeup counter,” she says. “When you go to put lipstick on the counter, say ‘By the way, is this the best you can do?’ And then wait. And talk through a smile,” she advises. As long as you’re pleasant, salespeople will try to accommodate bargain-hunters, often pulling a percentage-off coupon from under the counter.

Even if they can’t give you a discount, clerks may have the power to sweeten the deal in some other way. “Another time at Macy’s I bought furniture and had to wait for an extended period during my workday, so I said to the clerk, ‘I know it’s not your fault but what can you do to help me out?’ She took away the delivery fee and saved me $150,” she adds.

For examples of opportunities in which to practice your negotiation skills and ideas about effective strategies, check out the blog The Daily Asker. A graduate student, Roxana Popescu, set herself the goal of negotiating a request everyday. So, at the farmer’s market, she might ask, “How about an end of the day discount?” She would often get it, or a free sample, or a bonus bag of produce. Over the course of one year, she asked for a discount 411. Analyzing her success rate, she discovered that she did better when she was nice (80%) versus when she was meek (58%). Perhaps unsurprisingly, she enjoyed the greatest success (85%) when she was very nice, or even flirtatious.

Negotiate with Coworkers

Whether delivering direct patient care as a manager, researcher, or as an entrepreneur, nurses need effective negotiation skills. Not every nurse is in a role that requires negotiating with patients, students, vendors, clients, or external agencies. But almost universally, nurses must negotiate with colleagues and coworkers.

“I’m a double minority, a male nurse and an ethnic minority,” says Usama Saleh, RN, BSN, MSN, PhD, a nurse educator. “Nurses are about 90% ­female today, but when I started it was only 3 to 5% male. I always felt like a minority in terms of gender, so I had to learn to negotiate with female nurses. Naturally there are differences in terms of negotiation styles. But I need to be able to work effectively within a female dominate profession.”

Usama was working as an RN in oncology and often negotiated with colleagues about the assignment of patients, for instance, and to resolve conflict so all parties are satisfied. In addition to ensuring an equitable workload, “it’s important to negotiate with your nurse mates on the team in order to deliver effective care. I always look at it in terms of quality of care,” he explains.

Usama came to the U.S. from the Gaza Strip and also had to become accustomed to the negotiation style of Americans who were born and raised here. “Culture and religion influence the etiquette of negotiation,” he says. “I wasn’t able to be aggressive; I was a soft negotiator. I admired it when negotiators were more assertive, but because of cultural factors I couldn’t do it.”

Usama also taught in China for short while and saw how negotiation is different there, as it is throughout the Middle East. Though he can adjust his individual style to the culture, overall, he’s happy with it. “I believe using a softer negotiating style has given me good results. It’s softer than usual in the U.S., but it is still effective and I’m very satisfied with the outcomes,” he adds.

Now You’re Ready for Salary Negotiations

“When I speak to groups of nurses I have a joke: ­Everything in life is negotiable except for the salary of a staff nurse,” says Cardillo. Most hospitals have set salary ranges for nurses, sometimes negotiated by unions, until you go on to be a case ­manager, supervisor, or manager.

If you’re not sure if salary negotiation is appropriate in your role or organization, Cardillo suggests you probe with these phrases:

  • Is there any way to … ? (Boost salary, add benefits, etc.)
  • Are any adjustments available?
  • Is there any room for negotiation?

Where to get salary survey info: professional associations, National Association of Colleges and Employers (NACE), Salary.com, jobstar.org, bls.gov, medzilla.com, career fairs, career development centers, and coworkers.

Even if you can’t negotiate your initial salary, you may be able to negotiate during a wage and performance review or an improvement plan meeting. “Most of the time, nurses are nervous going in to that type of meeting,” says Podlesni. “Take ownership of the discussion and go in prepared with information and knowing your desired outcome.”

For example, in a performance evaluation where a nurse is judged poorly, he or she doesn’t have to accept an unfair assessment. In one such situation, “an emergency room nurse was told she did not have timely emergency room skills such as inserting NG tubes,” Podlesni recounts. “I advised her that evaluations need to be conducted fairly and use consistent criteria across that board…I recommended that she request a video or documentation of someone doing the skill in the timeframe suggested. They were unable to provide this, and as a result, she received her $10,000 annual salary increase.”

During a wage evaluation, you can always negotiate for a higher salary or better benefits package. “Say your salary is $60,000 a year,” Podlesni says. “What stops you from saying ‘I love my job and want to keep working here, but I need to get to $65,000 a year to spend that much time out of my home and to pay childcare expenses’?” You may not get that raise but at least it starts a conversation and then you can decide if you want to stay in the job or if it’s time to find a better paying employer.

Believe in Your Value

Minority nurses bring an extra dimension to their work that they may not recognize and value highly enough. “Being Latina and bilingual, bicultural, we’re typically in a culture that doesn’t boast,” says Adriana Perez, PhD, ANP-BC, FAAN, assistant professor of nursing at the University of Pennsylvania School of Nursing. “We’re taught that you have to be modest, don’t call attention to yourself. It’s about building relationships and taking care of others. We have to balance humility with self-confidence.”

At the National Hartford Centers of Gerontological Nursing Excellence leadership development program, Perez learned the essentials of career success, including salary negotiation.

“AACN publishes mid-to-average salaries for professors that might not factor in additional skills or expertise,” she explains. “I’m bilingual, board-certified adult nurse practitioner, and researcher addressing health equity issues that are national research priorities. There aren’t that many Latina nurse scientists so it puts me in a great bargaining position. I can help the school meet its inclusion and diversity mission. But that’s not enough. I have to produce results and demonstrate a measurable impact.”

Polish Your Negotiating Skills

Many organizations offer professional development workshops that focus on cultural diversity, communication skills, negotiation, and conflict resolution. The leadership program that Perez benefited from included a career-enhancing mentorship relationship.

“We grew from mentor and mentee to now colleagues and friends. I attribute a lot of my growth to that program,” she says. “I recommend finding mentors. Study the leaders in your organization whose style you like and who are well-respected. Ask them for coffee: ‘Can we schedule some time?’ Nurses are giving and want to help. They’ll share lessons learned and will tell you about programs, scholarships, training, and other resources out there.”

It’s true that some nurses will never enjoy advocating for themselves. But it doesn’t have to be that way, with a little practice they can increase their confidence and ability. The end result: Better outcomes for everyone.

How Nurses Can Make Better Financial Decisions

How Nurses Can Make Better Financial Decisions

Few nurses have a solid grounding in personal finance about making decisions about their own financial future. Money management can be overwhelming. But you don’t need to learn the fine points of microeconomics – just the fiscal facts that pack a wallop on your wallet.

The good news is that the economic outlook for most nurses is rosy. Employment prospects are strong, says Donna Cardillo, RN, nurse entrepreneur and inspirational/motivational speaker. “The job market for nurses is much better. The market is cyclical and always has been. The last slump lasted about seven years, but that has all changed and many employers are now offering sign-up bonuses,” she explains.

The bad news? Many nurses still struggle to lead financially empowered lives, rather than being slaves to debt or just getting by paycheck to paycheck. Here are nine ways to make powerful personal and career decisions.

Evaluate an Employer’s Salary and Benefits Package

Often nurses decide to accept a job offer based only on the hourly wage, without being aware of the entire salary structure and how it can drastically pump up your pay.

Jon Haws, RN, CCRN, nurse educator and founder of NRSNG, wrote a popular article about how he doubled his first-year earnings as a new nurse. In “How I Made Over $70,000 My First Year as a Nurse (how I learned to game the system),” he recounts his experience as a newly graduated critical care nurse at a Level I Trauma center in Dallas, Texas.

According to Haws, that article “is a bit dated and I realize the $70,000 is nothing to a California nurse, but I outline some step-by-step ways to really maximize what you can make right out of school.”

Some of his steps included grabbing the pay differential for nights and weekends, getting an automatic raise after 6 months and a year, and working overtime and bonus shifts. That strategy requires that you make yourself an expert on your HR department or union contract rules, of course, which may be difficult before you’re hired. Not every employer is transparent about its pay policies. It’s easy enough to check Payscale.com or Salary.com for comparisons. Also, be sure to consult with a tax professional about the ramifications of higher compensation—you want to be ready when the tax bill arrives.

“The benefits package is something that employees don’t always take into consideration, but it can be significant,” says Launette Woolforde, EdD, DNP, RN-BC, vice president for nursing education and professional development at Northwell Health in New Hyde Park, New York.

She encourages nurses to plan for the next step of their education and especially note those related benefits. “Some organizations offer employees some sort of tuition reimbursement plan. When you get a job and get through adapting to your new role as nurse, that’s the time to take advantage of those benefits.”

According to Woolforde, some organizations provide employees with a discounted rate or deferred payment options for a number of nursing schools. “So a $500 a credit may be reduced to $400 a credit and the student isn’t invoiced until after the class is over. By then the tuition reimbursement will have kicked in so students don’t suffer out of pocket expenses that disrupt their cashflow,” she says.

In addition, many organizations pay a stipend or differential based on a nurse’s educational achievements. “For example, let’s say the salary is $50,000 a year to start, but if a nurse has a bachelor’s degree, they may add $5,000 a year. If you’re certified they may add even more,” she explains.

Decide on Your Financial Priorities and Make Every Step a Learning Point

There may be a sunny employment outlook for nurses, but you still have to earn and save to fund your priorities. Not every nurse will have the same financial needs and not every nurse will experience life transitions in the same order. Yet, there are some goals, such as starting a family, buying a house, or early retirement, which many nurses aim to achieve and can—with some work on their inner and outer game.

“I made $35,000 or $45,000 my first years in nursing and had to figure out a way to increase income or reduce spending,” says Brittney Wilson, RN, BSN, nurse influencer at TheNerdyNurse.com. “I opened the door to those possibilities.” Wilson carried $40,000 in student debt that she now believes was avoidable, if she’d lived at home, attended a community college, worked a part-time job, etc.

As a young wife and mother, she tried many methods to economize, as she wasn’t emotionally able to work more hours at the bedside. “One example, I tried extreme couponing and was able to take our $600 grocery bill down to $100. I had to figure out a way to get diapers and formula for my baby,” she explains. Wilson started her blog a couple of years later, mainly for personal expression, but she also started getting free products and fees from brands. “People kept offering me money but initially I felt some guilt about it,” she says. “When I came to terms with it and actively decided to monetize my blog, I hung the ‘I’m available to be paid’ shingle directly, and even more offers came in.”

As Wilson felt more and more confident that she was providing a valuable service, she increased her ad and consulting rates, and focused her blog on her nursing specialty. “Earning extra income is like walking down a hospital hallway. It’s a journey. You can open each door and look around or keep going down the path. Just keep opening doors until you find the one that is right for you,” she advises other nurses.

Wilson got so good at earning and saving that she and her husband are on-track to pay off their house mortgage in a little over five years.

If you’d like to get better at the nuts and bolts of budgeting, bill paying, and tracking various financial accounts, you may want to try apps and programs like Mint.com. By corralling everything into one place, you get a better handle on your spending and saving, and can see in charts and graphs how well you’re doing with your finances.

There are also minority personal finance experts you can follow for advice from someone who figuratively speaks your language. For example, African American pros include Michelle Singletary, who writes “The Color of Money,” for The Washington Post and syndicates. Or, if you prefer podcasts, Rich Jones and Marcus Garrett host Paychecks & Balances for Millennials aiming to pay down debt

Decide When to Make Major Purchases

Even if a purchase is appropriate for your life stage, try to minimize your total household overhead. Even well-paid nurses risk fatigue from worry or overwork to manage bills and payments for one-time splurges or ongoing financial commitments.

Woolforde encourages nurses to carefully consider whether a major purchase is a sound money investment. “I see this often—the first thing a nurse graduate buys is a flashy, brand new car, as a reward for all that hard work in school. A flashy new car is nice but it’s a rapidly depreciating item as opposed maybe holding out for a down payment on a new home that appreciates for a good long-term return,” she explains.

You might decide that your next major investment will be in your own higher education or specialized training. If so, be sure to take advantage of employer-provided assistance programs before taking out large student loans. Maybe your current workplace has a tuition reimbursement plan if you’ll commit to working there after graduation, but you hesitate to limit your options. Find out how often graduates using that program decide to stay with that employer; usually the figure is high. If your circumstances and goals match theirs, you’re likely safe in taking the same route.

So many students lament how little they knew about educational loans that a free interactive game called Payback was created by a financial literacy non-profit. The makers warn: “College can help you realize your dreams, unless it leaves you with a student loan nightmare.” Students navigate an online maze of decisions: What school to attend, what major to declare, whether to focus on studies for a higher GPA or social life for more connections, etc. At the end, if a player does decide to borrow educational funds, it’s with eyes wide open.

Choose a Specialty That’s Fulfilling—And Remunerative

Whether you’re a new nurse graduate or you’ve been in the field for years, now might be a good time to switch to a specialty or workplace with better long-term prospects for pay and benefits.

Cardillo encourages nurses to explore non-traditional career options and to take risks. “Your next job may not pay as much, but may have many other advantages. When it comes to being a bedside clinical nurse in a hospital, there’s only so much you can make, even with overtime. Some other health care related industries have greater earning potential over the long run even if you have to take a pay cut in the short term,” she says.

Cardillo points to a variety of popular nurse settings and roles that pay well, such as: Nurse informatics, quality management nurse, corporate wellness nurse, insurance nurse, or nurse consultant.

You may also want to check out DiscoverNursing.com for interactive features that guide you through the process of choosing from scores of specialties. Some under-the-radar titles have surprising rewards, including high demand or ease of entry. You’ll get information on the education, training, and certification required to fill a role, as well as its average salary and employment outlook.

Decide to Cut Hours or Leave the Bedside Altogether

Reducing your hours to, say, care for a family can be a difficult choice that depends on many conditions, but it can be the right choice, if done right.

“If you opt to get out of the job market for a while, stay in touch with nursing colleagues through professional associations [and] keep up with credentials and licenses,” advises Cardillo. “Keep yourself current, marketable, and connected.” She warns that nurses who let their licenses lapse—accidentally or not—won’t be ready to jump back in when they need to or want to.

“Some nurses drop out of the workforce to take care of elderly parents, but then the parents die and they’re left with literally nothing and can’t find a job,” she warns.

Cardillo recommends that you first explore opportunities to work at home, which are more common today for nurses. If that’s not possible, check to see if your state allows for an inactive status license, rather than outright letting it lapse.

Another life stage when nurses may be tempted to let their license lapse is at retirement, but Cardillo sees downsides to that. “Nurses retire, but after so many years they get bored or financially need to work again because they don’t want a lower standard of living.”

Care for Yourself and Your Career Longevity

“Nurses are leaders—they advocate for their patients, but they struggle with advocating for themselves,” says Diane Neustadt, director of operations at New York-based Forest Hills Financial Group.

Her firm supports the National Association of Hispanic Nurses New York chapter, of which Neustadt is an active member. Because of her involvement with the chapter, she’s able to explain the importance of managing one’s own financial life in terms that nurses relate to. “I tell them it’s like being proactive about your own health. Nurses work long, unpredictable hours so self-care is so important: physically, emotionally, and spiritually. I’m a spiritual person and also know the importance of financial well-being—live one day at a time but not just for today.”

Neustadt believes in “protection first,” which means having enough insurance and the right kind. “Employer-sponsored benefits are a good thing,” she explains, “but not only may company benefits not be portable and go with you, generally those employer-provided benefits are minimum benefits and should be viewed as the base of benefits to build upon. Three areas that normally need attention are disability, additional retirement income, and long-term care.”

Make the Most of Expertise from Family, Friends, and Coworkers

Woolforde received informal money mentorship from two unexpected sources who guided her to become financially savvy. The first was her older brother, who went to college when she was in her senior year in high school and was surprised at the expenses beyond tuition that he hadn’t anticipated. “When he came home at his first break he told me frankly, ‘You’re going to have to get scholarship money if you plan on going to college.’ So, we spent countless hours in the library combing through books and catalogs looking for scholarships. That was before everything was available online.”

She was doubtful about her ability to garner scholarship funds—others will have a higher GPA, more financial need, better applications. “At first, I said, ‘there’s no way I’m going to get it’ and he said, ‘you don’t know until you try,’” she explains. After piecing together several small scholarships—$600 here and $2,000 there from various sources—Woolforde was able to fund her freshman year at a commuter college. Good grades allowed her to garner full scholarship funding for the rest of her bachelor’s degree in nursing.

Woolforde next got valuable advice from a nurse preceptor who insisted they visit the hospital credit union after one shift. “She helped me open a retirement account and set up direct deposit of part of my paycheck into that account. I was just starting my career, so retirement was the farthest thing from my mind as a 21-year-old,” she says.

Try to find a money mentor who understands your situation and connects or relates to you in that way, advises Woolforde. “My brother understood the home situation and my preceptor maybe recognized me as her younger self—she was an African American female, too. Everyone who has walked this path, grown in professionalism, grown in a nursing career, it’s our responsibility to share what we’ve learned,” she says.

Make the Most of Your Employer’s Financial Programs

Your organization may offer employee benefit education, such as having an HR representative provide short updates at staff meetings, or making a vendor available for one-on-one consultations. Take advantage of these resources if they can help you fill in the financial puzzle pieces of your life.

“My family emigrated from Armenia when I was nine years old,” says Anna Dermenchyan, RN, MSN, CCRN-K, senior clinical quality specialist in the Department of Medicine at UCLA Health and a PhD student at UCLA School of Nursing. “At the time, my parents didn’t know the language or the culture, and thus we struggled financially as a family.”  When she worked at a bank as a senior in high school, she learned about financial concepts and became more proactive about managing money.

Dermenchyan now actively engages with the University of California system’s excellent financial program for employees and students, which include onsite classes as well as live webinars on financial wellness and retirement.

“I’m an early Millennial and we think about work-life balance and living in the moment, and this necessarily doesn’t help us save enough money for the future. We want to earn, spend, travel, and just enjoy life,” she explains. “However, financial health is part of achieving wellness and maximizing potential benefits for the future. Just like with Maslow’s hierarchy of needs—personal finance is at the basic level, and everything rests on it.”

Most nursing schools don’t include a financial component in the curriculum, so many workplaces fill in the gaps with seminars, consultations, and program “nudges” to encourage fiscal health. “At first, I just put in $100 a month towards retirement; that’s what I could afford after paying loans and family expenses,” says Dermenchyan. “The automatic deduction from each paycheck makes it easier, and some institutions make a matching contribution. In addition, I was advised by a financial consultant that with every salary increase, I should increase my contribution to retirement,” and she has continued to ramp up her rate of saving and investing.

Prepare for Retirement

Some nurse leaders point to numbers of disengaged older nurses who are forced to continue working because of under-funded retirement plans. They didn’t put aside enough money for the future, and early social security payouts at 64 are too small to support even modest lifestyles.

“Nurses are unlike other caring professions—police, firefighters, and teachers—because they don’t earn pensions from municipal government employers,” says Ric Edelman, a #1 New York Times bestselling author of personal finance books such as The Truth About Money and The Truth About Retirement Plans and IRAs. “That puts their financial future in jeopardy.”

Edelman is also the founder of Edelman Financial, one of the nation’s largest independent financial planning firms. His firm offers a free financial plan to nurses, waiving its customary fee for the two-meeting process—either in person or via teleconferencing—which results in recommendations for investments, insurance, estate planning, and more.

By starting the process toward financial stability and independence, you can empower yourself as an earner, saver, and investor. It is possible to experience the feeling of security that comes from having your financial life firmly in hand. This moment is the best time to take that first step.

Ace the NCLEX and Clear the Final Hurdle to Practice

Ace the NCLEX and Clear the Final Hurdle to Practice

Often it’s not nursing knowledge that makes the difference in passing nursing boards, but having strategies for answering questions so that it’s apparent that you really “get it.” There are ways to prepare for what is often a daunting test so you can take it with complete confidence that all the time, money, and hard work that went into nursing school won’t go to waste. We interviewed experts, educators, and other nurses who aced these exams—first time around or later—and share their most helpful hints with you here.

Jake Schubert, RN, BSN
Travel nurse and executive director of Nursity.com, an online NCLEX strategies and review course

jake-schubert1. Carefully consider your options.

“The average candidate takes one or two prep or review course, and spends an additional 40 to 50 hours on other independent study,” according to Schubert. He recommends that students talk to their peers about their experiences and read online testimonials. In addition, check to see if your school has partnered with a test-preparation program. “Some schools provide review courses as part of the capstone curricula—ATI, Kaplan, and HESI are the big corporations with relationships with many of the schools. Most students take an additional course as well,” he adds.

2. Understand the NCLEX format and how it works.

“When you intimately know the beast, it won’t be as intimidating,” says Schubert. Because this is a computer adaptive test that uses algorithms, it’s different from every other test students have taken in their entire academic career. You must also prepare for it differently. “If you did exceptionally well or performed extremely poorly, the exam will end at 75 questions,” he explains. But if you are somewhere in the middle, it can go up to 265 questions to assess how well you know the material and whether you’ll be able to perform as a nurse in a safe manner. (See Schubert’s YouTube video—“How to Pass the NCLEX with a 58%” for more details about this type of test.)

3. Strategize how you will approach questions in which you don’t know the answer.

Most students who graduate from nursing school have sufficient content knowledge, but because the test is computer adaptive it will find an area where you are weak, says Schubert. “The NCLEX will assess your judgment as much as anything else.” What will you do when you don’t know what to do? You need strategies for these types of questions. “How do you answer a question about content you never learned? Strategy. Ask yourself, ‘Why did they write this question? Is it a medication question? A judgment question?’ As a new graduate nurse, that’s all you do all day, is try to figure out what to do in situations you don’t necessarily fully understand. This is much of what the NCLEX is assessing—will you make a safe decision?” he adds.

4. Don’t wait to study or take the exam.

The longer you wait, the more you forget, and the worst you score. “Take the exam immediately after graduating from nursing school,” Schubert advises. “Begin studying for the NCLEX before you graduate, to keep the material fresh in your mind, which will improve your score. Pass rates go down the longer a candidate waits after graduation,” he says. To find out more about pass rates, we recommend you go directly to the source: the National Council of State Boards of Nursing website at www.ncsbn.org.

5. Figure out the best way for you to study, and then stick with your plan.

“Keeping to a study schedule and certain days and times is important,” says Schubert. “But don’t cram. Instead, spread it out over a longer period.” He also recommends reducing distractions, such as television, devices, and social media as well as calls or visits from family and friends. Make sure your study area and equipment are well set up so that you’re comfortable during each study session. Then take frequent breaks so that you don’t deplete your energy, and switch among various subjects every half hour or so to maintain focus.

Launette Woolforde, EdD, DNP, RN-BC
Vice president of system nursing education at Northwell Health in New Hyde Park, New York

launette-woolforde1. Find a role model with a similar background.

“When you don’t have minority role models that reflect who you are, it can hamper your optimism and pursuit of certain goals,” says Woolforde. “For example, I remember reading that 12% of the U.S. population is African American, but only 2% of nurses in the workforce are African American.” The lack of role models may extend to educators, staff, and mentors who can help monitor and guide students. On the other hand, those missing pieces of the career puzzle “can serve to motivate students to start a new trend and make a clean break from what’s happened before,” she adds.

2. Be aware that factors such as language, cultural norms, and your environment can influence your standardized testing experience.

Being a first-generation nurse or college student, for example, means you have to figure out your own way around in academia and career preparation, says Woolforde. “Minority nurses might not fit the norm in their family or culture. But I’m happy to see so many nurses exceeding these norms. Soon, minorities will be the majority in the U.S.”
Minority test-takers may have to “think against” their own cultural norms, cautions Woolforde. “Maybe in your culture women do not make decisions. You have a question about a patient coming into the ER—a male with a wife—and the wife is upset and vocal about it. How would you answer the question? The correct response is ‘Reassure the wife,’ but what if in your culture, wives aren’t spoken to? A wife may be dismissed in that culture.”

3. Do two or three things to “pump yourself up” each day.

“Overthinking and overprocessing while studying is a problem,” says Woolforde. “Don’t try to master everything. Do a little bit every day. Take tests over and over. Spend more time doing practice tests than in reviewing your general knowledge.” Some review services provide assessments, so take a look at your pharmacology scores, for instance, and decide if you need to allocate more time to that section of the test. Nursing students know a lot, but when they look at the questions they may not understand what the question is really asking. “It’s not ‘What is this medication for?’ but more about ‘What would you do to prepare a patient?’ For example, if a patient is taking Lasix then he needs a diet that’s rich in potassium,” she says. “Review what you’ve learned over the years. Believe in yourself. You’ve come this far, so you can pass this exam. There’s great positivity that comes from that belief. There’s power there.”

4. Don’t let fear hold you back.

Fear of failure and fear of the unknown are two major hurdles for many minority nursing students, says Woolforde. “They ask, ‘Am I smart enough?’ They’re afraid that they’ll fail the test because they don’t know the right answers. They’re afraid there’s material that they didn’t get in school or that they didn’t study it enough. I usually tell them all that might be true—you might not know the answer outright. But you can usually rule out two answers and reduce your choices. Then reread the question, think about it, and let the right answer surface,” she advises.

5. Think beyond the NCLEX.

“Even during your orientation, you can be thinking about specialty certification,” says Woolforde. “If you work in oncology and pediatrics but like peds, then you may decide, ‘This is where I want to spend my career.’” Next, consider specialty board certification as a stamp of expertise in an area of practice. In order to maintain that certification, you have to maintain a minimum number of continuing education hours and must practice for a minimum number of hours there. “Certification shows that you’re current with best practices; you’re currently practicing and staying on top of trends and issues in that specialty,” she adds.

G. Rumay Alexander, EdD, RN, FAAN
Interim chief diversity officer and director of the Office of Inclusive Excellence in the School of Nursing at the University of North Carolina at Chapel Hill

1g-rumay-alexander. Keep your mind in the game.

For highly vulnerable students, every test becomes a test of language proficiency, says Alexander. Multiple choice questions are especially problematic, she adds, so practice to understand how they’re structured and how to answer them. “Outside of the U.S., most countries don’t use multiple choice questions on tests, so international students may need more help to pass. Non-English speakers typically need to translate questions into their own language and then retranslate their answer in English. Older students are another minority group that is disadvantaged; they’re out of practice with test-taking.”

2. Understand that half the battle is staying level-headed.

“Try not to let your brain get hijacked by emotions,” advises Alexander. “Avoid being hungry, angry, lonely, or tired [“H.A.L.T.” is a good memory aid]. Make sure you’re well-nourished, well-rested, and really and truly try not to get panicked because you don’t know the answer immediately. Answer the questions you are certain you know and then revisit the questions you skipped.” It’s normal for people taking the NCLEX to think that they’re failing, so try not to be overwhelmed if you need to skip questions. Usually, you are doing fine, so just stay the course.

3. Tap the various staff members and other resources that your school provides.

“We have student advisors who meet with students and take them through different tests and practice exams,” says Alexander. Practice questions come from the end of textbooks, or students go online and get questions that best address their weak spots. “Students who have test anxiety can get help at a center that helps with managing anxiety and practice with testing, too,” she adds.

4. Find your happy place.

When highly vulnerable students were not passing gatekeeper exams at her school, Alexander asked the school’s “cultural coaches” to work with them. “We told the distressed group to forget about the exam and we asked them this question: ‘If you didn’t have that coming up, what would you do?’ Their response was ‘Let’s have a party!’ so we blasted music for 40 minutes and they taught each other new dances. There was laughter, joy, and smiles. Then they went on to study for the exam.” The nursing students were advised to do visualization exercises for stress reduction, like the school’s winning basketball team did before a game. “We told them, ‘When you’re stuck on a question during the exam, go back to this time. Remember the dance or anything that makes you feel peace, joy, or sense of accomplishment.’” The visualizations worked, and students later reported that their anxiety was greatly reduced when they applied the technique.

5. Understand that not everyone will pass the exam on the first try—and that’s OK.

“If you failed, well, you’re not the first person who has,” says Alexander. “Maybe you need to practice more or review a certain part again. Students repeat exams all the time. It’s not a denial of your dream; it’s a delay. Maybe you need to work more on test anxiety or preparation. Failing should inform you, not defeat you.”

Sometimes students face difficulties right before the exam that throw them off course, such as a suddenly ill child or a minor fender bender. Everybody has a bad day, Alexander explains, and the main thing is to resist the urge to ruminate. “Instead, focus on what’s next,” she suggests. “Ask yourself, ‘What do I want? What’s my next move?’ Remember, there is a skill to test-taking and it takes intentional preparation. Prepare, don’t despair!”

There are so many ways to prepare for the nursing boards now, what with new technology as well as in real-life social support. You can pick and choose the techniques that work best for you. Take an online review course, use an app, study with a group, or set up an at-home program. Success is absolutely within your reach!

The New Health Care Workplace

The New Health Care Workplace

As you know, health care is opening to a world of opportunities, as we’ve seen sweeping changes unlike any other in the last five decades. Social, political, economic, and technological trends form a “perfect storm.” Today’s nurses are trailblazing new roads in the profession, as they adopt different roles and operate in nontraditional workplace settings.

Nurses today still care for patients, but they must also provide it in the right manner, at the right time, and in the right place. Health care organizations still seek to provide the best patient experience, but they also must cut costs, boost outcomes, and ensure safety. There is growing demand for registered nurses, both in and outside hospital doors, that demands caretakers develop a new skillset and a new mindset. Below are five ways that demonstrate how nursing has morphed and shape-shifted recently, and how nurses can make the most of tomorrow’s opportunities.

Trend #1: Jobs are moving outside of hospitals.

Inpatient units—and sometimes whole hospitals—are being closed and patients are being moved into alternative settings, such as long-term care, rehab, and subacute care facilities. Case in point: Experts estimate that today 65% of health care services are delivered in ambulatory settings, rather than hospitals. That transition from inpatient to ambulatory care settings occurred slowly over the past decade.

Why the switch? The Patient Protection and Affordable Care Act of 2010 was a major factor that hastened what hospitals were already doing: offering services outside their doors. Health care organizations want to cut down on admissions (and re-admissions), and they seek to do that by pumping up preventive care and caring for patients at home, or on an outpatient and community basis.

Andrea Higham leads Johnson & Johnson’s Campaign for Nursing’s Future, launched in 2002 to recruit and retain more nurses and nursing faculty, including minority, male, and other underrepresented groups. “Nursing is at a very exciting time, and nurses are on the frontline of health care, providing delivery of care across the board,” says Higham. “So many people are entering health care because of a confluence of so many forces, such as the Affordable Care Act and an aging population. Nurses are working not just in hospitals, but also in home health care, at clinics, as advanced practice nurses, and managing the entire health care journey. There’s a strong need for nurses in many places outside of the traditional health care setting.”

Think about opportunities outside of the hospital. For example, if you’re interested in pediatrics or working with adolescents, consider openings in pediatric long-term care, pediatric home care, pediatric rehab, or at group homes for children or teens.

According to Phyllis Quinlan, PhD, RN-BC, president of MFW Consultants to Professionals and a nursing coach, nontraditional settings, such as subacute care, are fine places to practice if applicants can overcome their preconceptions. “Long ago and far away, it was considered grandma’s nursing home, but now it’s a combination of residential care and short-term rehabilitation. It could even include pediatric or non-geriatric care,” she explains. “Hospitals are shutting down med-surg floors, and shifting patients to other, lower-cost venues for treatment. Say someone falls and breaks a hip—now they have to learn how to walk with that new hip. That’s when they need bridge care—skilled care, rehabilitation, nursing care—until they can go back home. It’s not about disease care anymore, but about preventative care and home care for managing diseases today. Hospitals soon will be only for emergency care, cardiac care, burns, traumatic injury, [and] cancer centers.”

In addition, health care organizations within the private, government, and nonprofit sectors also need qualified registered nurse candidates to fill the high demand for traditional and alternative roles.

Trend #2: New or returning nurses must develop job-search savvy and resolve to land coveted hospital positions.

“For those new graduates hoping for good med-surg experience after nursing school but can’t get a job in a hospital, don’t despair,” says Quinlan, even though hospitals have adopted stringent nurse recruiting requirements and sought to cut costs in every way without compromising care.

“Most urban area hospitals aren’t hiring, but in other areas, that’s not the case,” she explains, suggesting that new grads and nurses with some experience apply for residency or internship programs to “fast track” their careers with intensive preparation for 12 to 18 months.

“Some health care systems are rich with nursing training resources, others do it but in a more conventional way,” she adds. Another way to get your foot in the door at a hospital: “Move to [an] area where they are hiring. The State of Texas is hiring new nurses, and other states are recruiting nurses to serve a special need or a growing population.”

Nurses who are open to filling short-term temp assignments also have a leg up on other candidates; hospitals are offering six-month contracts rather than making long-term commitments they may not be able to honor.

Trend #3: Nurses must further education, clinical skills, and knowledge to keep up with complexities.

Once, a two-year associate’s program could prepare a nurse for a secure and fulfilling career. Not anymore. “Most places now will hire a nurse with an associate’s degree but ask that she sign a hiring agreement to get a baccalaureate within five years or so,” says Quinlan. “Across the 50 states, the culture varies, but independent facilities and major health systems tell me ‘we’ll only hire baccalaureate-trained nurses,’ so you need to make your peace with the fact that the minimum preparation for practice is now a bachelor’s in nursing.”

The other source of tidal change is digital technology and big data, which make it possible for nurses to do more with their expertise and deliver care from practically any corner of the world, while enjoying the advantages of telecommuting, like other professions.

“Technology allows nurses to practice off the beaten path in more ways than ever before,” says Brittney Wilson, RN, BSN, also known as The Nerdy Nurse. “With jobs like remote case management, telephone triage, and even informatics consulting, nurses can use the clinical knowledge and technical skills to help patients from the comfort of their home.

“Opportunities to work from home and attend to patient care needs virtually do come with a price,” adds Wilson, who is a nurse expert with experience as a clinical informatics nurse. “You have to have above-average computer skills and must be able to learn new software quickly.”

There’s a big need for nurses who have a business background. Traditional nursing programs do not address business aspects of health care. Nurses who go on for a master’s degree in business administration or health administration will understand policies and procedures that are governing health care now.

Trend #4: Nurses must focus on their own personal and career development to progress in the profession.

Clinical and other technical skills are important for any nurse to develop, but so are “soft skills”—for example, effective communication and problem-solving know-how.

“New to nursing? Maybe you have great ideas, but maybe you’re missing skills in how to talk to a patient or family members or how to collaborate with others,” says Higham. “You can always access our avatar-based online program, Your Future in Nursing, on the Campaign’s website.” The cutting-edge format, a game-like simulation environment for practicing key on-the-job concepts and skills, helps a student nurse prepare to make the often tough transition to practicing nurse.

Accelerating change in the health care workplace may require that new and seasoned nurses adjust their attitude and become more flexible about new ways of doing things. According to Quinlan, author of the recently published Rediscover the Joy of Being A Nurse: A Holistic Approach to Recovery from Compassion Fatigue, there’s no point in lamenting the good old days. “Nurses are some of the most creative people on the planet; they’ll make something out of nothing on a daily basis,” she says. “Some feel that they’re expected to adjust instantly to changing conditions and expectations, and they resent it. Those nurses must make peace with the new health care environment, themselves, and their profession.”

Until then, “they’re at a crossroads, and risk starting to swing to the dark side, having lost connection with the joy of practicing,” Quinlan adds.

Trend #5: Nurses will take on expanded and pivotal roles as part of tomorrow’s health care team.

How will we prepare nurses to transition to these advanced practice roles? That question has long been central for Donna Tanzi, MPS, RN-BC, NE-BC, director of nursing education and innovation at North Shore-LIJ Huntington Hospital in New York. “Nurses are going into master’s programs early on in their careers—after getting a baccalaureate, they’re going straight into a master’s or even doctoral degrees,” she says. “They have less clinical experience prior to getting an advanced degree, so we have an obligation as a profession to support them. Entry to DNP takes seven years from entry to graduation, similar to the medical model.”

Tanzi recommends nurse residency programs or fellowship programs for an extensive, tiered approach as students make the transition into their complex new roles.

“Nurses were tending to leave a job in the first year, or to leave nursing totally, because they weren’t prepared for the demands of the role,” she explains. “The bottom line and the message that I want to get out there is go into nursing for the right reasons. Recognize it’s an art and a science and we have the ability to impact people’s lives every day. Continue learning—there [are] always new directions and avenues to explore. There’s no reason to ever become stagnate or get bored in nursing; there are too many opportunities.”

There are many areas where advanced practice nurses apply their expertise gained through a master’s (or increasingly, a doctorate) in nursing or a related field. Clinical nurse practitioners are opening independent practices, or working with an academic affiliation in hospitals, or affiliated with physicians in their practices. Administrative leadership roles usually call for an MBA or MHA. Demand for nurses continues, so we need nurses to teach in nursing schools. At a minimum, instructors must have a master’s in nursing or in nursing education. Entrepreneurship, consulting, and research and development are also growth areas for advanced practice nurses.

Everywhere we look, nurses are being called on to surf the tidal waves of a changing health care environment and the emerging opportunities that come forth from it. Tomorrow’s nurses, with the right technical skills and personal qualities, can look forward to a rewarding career where they can deliver even greater value to their patients and communities.


Photo courtesy of Johnson & Johnson

What’s Your Dream for 2016?

What’s Your Dream for 2016?

Today is Martin Luther King Jr. Day, so naturally we remember Dr. King’s “I have a Dream” speech. As you may know, he delivered the stirring message in 1963 at the March on Washington, in a dramatic and impassioned call for an end to racism.

What you might not know is that his address to the nation is ranked by scholars as the top American speech in U.S. 20th century history! It still lives on for everyone moved by his dream of equality.

But some people, especially younger Americans, have forgotten the reason for MLK Day. To them it’s just another three-day weekend, like President’s Day. Mainly, they ponder whether to go to the shore or to the mountains or to stay at home and binge-watch Netflix.

One way we can be reminded and reinspired by Dr. King is by viewing the movie about a major episode in his dramatic life, Selma. This phenomonal film is racking up accolades and awards, including at the Golden Globes. Some believe it was snubbed at the Oscar — it’s nominated only for Best Picture and Best Song, and not for its many fine performances or the strong vision of its young, female, African-American director. You can see a trailer and find out more here. It’s playing at theaters in major markets throught the US.

Another thing we can do is to read the entire “Dream” speech here. Amazingly Dr. King almost didn’t deliver it because his adviser, the Rev. Wyatt Tee Walker, feared it was “hackneyed and trite.” Right before the march, Walker and his staff drafted a replacement titled, “Normalcy Never Again.” (Doesn’t quite have the same ring, does it?)

Gospel singer Mahalia Jackson is responsible for Dr. King’s change of heart; she called out to him, “Tell ’em about the dream, Martin” as he started speaking. He paused and said, “I still have a dream.”

Here is one small, electrifying snippet from his address to the crowd:

“I still have a dream, a dream deeply rooted in the American dream – one day this nation will rise up and live up to its creed, ‘We hold these truths to be self evident: that all men are created equal.’ I have a dream…”

Maybe you don’t consider yourself a dreamer. Most nurses are practical, ingenious workers and their patients and communities value them highly for their hands-on care. But most likely you do hold tight to dreams of equality, freedom, and compassion on Earth.

There are so many ways to affect social justice as a nurse, even if it’s just in your own little corner of the world. How does your heart and imagination inspire you to act? What is your dream for 2016? We’d love to hear about it.

Jebra Turner is a freelance health and business writer in Portland, Oregon. Visit her online at www.jebra.com.