Full Practice Authority Gains Ground in 26 States: What This Means for Nurse Practitioners 

Full Practice Authority Gains Ground in 26 States: What This Means for Nurse Practitioners 

In the long struggle to gain full practice authority (FPA), nurse practitioners (NPs) can point to notable advances in the last few years. Now, patients in more than half of the states, the District of Columbia, and two U.S. territories have full, direct healthcare access from NPs.

In April 2022, New York and Kansas granted FPA to NPs. That brings to 26 the number of states where NPs can practice to the top of their license without restriction. In this article, we’ll look at how that progress was made, the impact of COVID, and how newly proposed federal legislation would strengthen NP practice. But first, let’s have a look at what FPA means.

 

Defining FPA

“Full practice authority is essentially that the nurse practitioner can practice to the full extent of their education and training,” says April N. Kapu, DNP, APRN, ACNP-BC, FAANP, FCCM, FAAN, president of the American Association of Nurse Practitioners (AANP). “Nurse practitioners are trained to evaluate patients, make diagnoses, order and interpret tests, prescribe medications, coordinate care, and educate. We are educated and trained to do these things,” says Kapu.

In the past few years, the pace has “really picked up as we have seen more and more states move to full practice authority,” according to Kapu. She notes that four states moved to full practice authority through the pandemic: Delaware and Massachusetts in 2021 and New York and Kansas in 2022. “It’s because we demonstrate our commitment to quality and equitable care and ensuring care is provided in all communities.”

In states that have moved to full practice authority, “we’ve seen improved patient care outcomes. We’ve seen an increase in the workforce. We’ve seen an increase in nurse practitioners working in historically underserved urban and rural areas,” Kapu says.

COVID and Care

While devastating, COVID helped bring to light the high-quality care that NPs provide and boosted efforts to gain FPA. In some states where NPs worked under less than full practice authority, the governors signed executive orders waiving various restrictions, notes Kapu.

“That’s where we saw the opportunity for nurse practitioners to continue providing care. They provided very high-quality care. They were able to provide more accessible care. As you saw throughout the pandemic, they were in communities and churches, going door to door, seeing patients in their homes, and doing everything they did in the hospital and the ICUs. So we demonstrated that continued quality of care. And that is what quickened the momentum during the pandemic; the executive orders provided that opportunity,” Kapu says.

Ohio Experience

In Ohio, a reduced practice state, an emergency authorization during COVID allowed NPs to deliver care via telehealth, notes Evelyn Duffy, DNP, AGPCNP-BC, APRN-NP. However, she notes that NPs can still practice via telehealth, and that ability is no longer contingent on emergency authorization. Based in Cleveland, Duffy is an NP in the University Hospitals Geriatric Medical Group and a professor at the Frances Payne Bolton School of Nursing.

An NP since 1981, Duffy notes that “we’ve come a long way in Ohio. We got full prescriptive authority at the end of the 1990s.”

However, like all Ohio NPs, Duffy needs a collaborative agreement with a doctor. “Ohio is in the reduced practice category,” she notes. “Not a lot obstructs me from doing what I want. The only thing that gets in the way is having to make that collaborative arrangement.”

Overcoming Obstacles

Kapu stresses the need to get out the message that laws limiting NP practice need to be revised. Laws need to be updated to “allow NPs to practice to the extent of their education and training, not beyond that, but to the extent of their education and training, as they are very capable of doing and have decades and decades of evidence demonstrating their quality-of-care outcomes. So it’s getting that message out that all we have to do is update those laws. It’s no cost or delay and can be put into place, and you would see much-increased access.”

Kapu points to Arizona as an example of what may happen for states that grant FPA. Arizona, she notes, moved to FPA in 2001.  Five years later, the NP workforce doubled, and rural areas saw a 70% increase in NPs.

Federal Legislation

On the federal level, new legislation, the Improving Care and Access to Nurses (ICAN) Act, was introduced in September in the House of Representatives. Supported by the AANP and other major nursing organizations, the act would update Medicare and Medicaid to enable advanced practice nurses to practice to the top of their education and clinical training, according to a press release from the American Nurses Association.

Maintaining Momentum

Although getting FPA in all states has taken a little longer than wanted, “we have momentum,” says Kapu. “I believe we’ll get there, especially with the increasing access to care needs that we’re seeing in the United States today.”

Career Moves: From Shift Nurse to Leadership

Career Moves: From Shift Nurse to Leadership

You’ve been working as a shift nurse for a few years. You love it, and you love caring for patients. But there’s always been something else calling to you: leadership.

How do you start? What steps should you take? Do you need more education?

Don’t worry; we’ve got you covered.

Making the Shift to Leadership

 

“Think about how you want to influence the health care system at large,” says Rachel Neill, MSN, RN, CPPS, Founder of InnovatRN Consulting, Chief Clinical Advisor for HealthEdGlobal, and a Clinician Advocate at Vivian Health. “Leadership roles often provide opportunities to affect change at higher levels and support health care teams across disciplines.”

If you’re not certain that leadership is for you, Ophelia M. Byers, DNP, APRN, WHNP-BC, NEA-BC, CPXP, CDE, Chief Nursing Office, Overlook Medical Center, and Associate Chief Nurse Executive, Atlantic Health System says “it’s important to gain knowledge that will inform decision-making.” Read nurse leadership textbooks, journal articles, and books by or including nurse leaders. She suggests Fast Facts for Making the Most of Your Career in Nursing, edited by Dr. Rhoda Redulla.

Once you’ve decided to move to leadership, Byers says you need to determine your track. “There are two formal leadership roles: supervisory/managerial and non-supervisory/functional. In supervisory or managerial leadership, the leader has direct and indirect reports that comprise a team and is responsible for the care of those people and the operation, e.g., staff on a clinical unit. In non-supervisory or functional leadership, the leader does not have any reporting team members but rather is responsible for overseeing a specific function (e.g., Nurse Educator) or program (e.g., Magnet Program Director),” she explains.

Find a mentor, says Desiree Hodges, MBA, RN, CCRN, NE-BC, The Vice President of Care Services at the ALS Association North Carolina. “Having someone in your corner is truly key. I recommend having a trusted source give you a 360 evaluation, taking personality surveys, etc. We all have blind spots when it comes to communication, which allows you to recognize your bias,” she explains.

Know about the tasks you may be doing that you aren’t doing now. “You may oversee budgets, organize staff training, and otherwise ensure that nurses follow the right procedures and protocols,” advises Kelly Conklin, MSN, CENP, SVP, Chief Clinical Officer for PerfectServe.

If you don’t have that experience, you may need to earn a higher degree than the one you hold and/or obtain certifications. “Know your organization’s requirements, reach out to your current leader and discuss your plans to obtain the necessary degrees or certifications,” says Hodges. “The American Association of Critical-Care Nurses has an online course designed just for nurses new to leadership roles that cover the basics of finance, human resources, safety, and quality, as well as the leadership skills to be successful in the role of nurse manager.”

Trust your instincts as well, Neill says. And don’t forget your experiences as a nurse at patients’ bedsides. “When moving into a leadership role, it is important to have a direct leader and health care system that will support you as you navigate this transition. In addition, the nurse leader serves as the first-line advocate for the nurses doing the daily work. You cannot support the nurses adequately without a team/system to support you as a leader,” she says.

Conklin says that no matter what you choose to do, “Don’t cut yourself off from opportunities—whatever they may be—that challenge your thinking and bring you to a higher knowledge.”

Tips on Passing the NCLEX Exam

Tips on Passing the NCLEX Exam

The National Council Licensure Examination is a prerequisite for becoming a nurse, and with increased nursing school applicants, we thought it would be worthwhile to offer tips on how best to pass the NCLEX. We each tried our techniques and utilized similar options to help us pass the exam in May of this year. With some guidance from our parents, we also have plenty of tips to help others pass this challenging exam with much more confidence than you otherwise might have exhibited.

 

Watch Tips and Tutorials on YouTube

YouTube has tons of great material on every subject, including the NCLEX. We recommend finding some tutorials and tips to help you pass. Shannon, in particular, used this study method for subjects she didn’t fully understand. It enables you to gain knowledge in areas where you’re lacking and is just a fun, easy way to gain more information and help you feel more confident with that material.

Allot Yourself So Many NCLEX Questions Per Day

Don’t try to push yourself to get through hundreds of practice questions when you don’t have the mental capacity. Instead, give yourself a few months to take your time and practice until you feel comfortable. It’s best to allot yourself so many questions daily and only focus on getting through one set at a time. Shannon stuck with the 75 questions per day rule, and it helped.

You can also go with Kristyn’s technique and allot yourself so many daily topics. Then, pick two or three and work on the material until you feel like you’ve nailed it. She spent one month working this way until she felt confident she could pass the test.

Study and Correct Your Incorrect Answers

By only focusing on so many questions each day, you have time to go back over the answers. You can correct anything you got wrong and take the time to understand why it was wrong. Then, use your results to help you study better and refocus on the problems you’re having trouble tackling.

Let Your Family Help

You don’t have to do this alone. Sure, you’ll be the only one taking the test, but that doesn’t mean you can’t get help practicing and preparing in the meantime. Let your family help you in any way they can—we both did. Kristyn’s mom helped her by being a pretend patient. Her aunt and uncle let her stay with them while in college to help save on costs. Shannon’s dad tried to help keep their dog occupied, so he wasn’t in her way or disturbing her studies.

Be Sure to Eat Healthily

Speaking of Shannon’s dad, Mark stresses the importance of eating well. It’s important to eat something healthy and keep your body full and your brain working to the best of its ability while studying and before you have a big exam. So, eat something healthy and keep your body full and your brain working to the best of its ability. That will go a long way toward ensuring you can pass your NCLEX without the pangs of hunger interrupting your thought process.

Also, Enjoy a Snack

You don’t have to eat all the time healthily, however. Sometimes, it’s good to get your favorite snack and reward yourself a little for the hard work you’ve been doing. So, grab your favorite candy bar and savor every bite before you get back to the work at hand. That little bit of goodness in your day can be a huge motivator and help when feeling down.

Add Vitamin D to Your Day

It’s also essential to make sure you’re staying healthy overall. Adding Vitamin D to your day, especially by soaking it up outside, is beneficial for how you feel mentally. Don’t just sit and study for the entire day. Get outside. Enjoy the fresh air. Take the break you need and deserve. It will help give you mental clarity so you can return to your study routine afterward.

Utilize UWorld

One of the best things you can do for yourself (or a family member) is to purchase a pretest system that allows you to see how well you would do on your NCLEX. It’s excellent practice and shows you the areas where you need additional guidance before you take the actual test. We used UWorld, and it offers options for both RNs and PNs. It helped us gain the information and experience necessary to help us feel genuinely prepared for the exam in real life. In addition, the UWorld NCLEX-RNⓇ provides more than 2,000 questions to help prepare for your impending. If you want easy-to-understand information, this program is for you.

Take Your Time During the NCLEX

Our final piece of advice is to take your time. It isn’t necessary to feel rushed during the NCLEX because you get five total hours for the entirety of it. Don’t rush through any questions. Please read it thoroughly so that you’re entirely comprehending what it’s asking. Some questions can be tricky, and you’ll misinterpret what it’s asking for if you don’t read them all the way through and give yourself time to sort through the possible answers.

Why Preparing to Be a Nurse Is So Important

It takes a village to support nursing students and current nurses, particularly given the added stress of the pandemic. In addition, as current nurses are exiting the profession due to burnout or attrition in large numbers, student nurses must find the resources they need to support their academic and career goals. A family and friends support network can also help make all the difference in reaching your goal of being a nurse with a healthy work-life balance.

This article written by Shannon Rosen and Kristyn Smith was published in the September 2022 issue of Minority Nurse. 

About the authors

Shannon Rosen graduated from Nova Southeastern University, passed the NCLEX in May 2022, and is an Operating Room Nurse at Naples Community Hospital in Naples, Florida.

Kristyn Smith graduated from Chamberlain University, passed the NCLEX in May 2022, and is a Pediatric ER Nurse at a hospital in Houston, Texas.

 

Full Practice Authority Gains Ground in 26 States: What This Means for Nurse Practitioners 

Full Practice Authority Gains Ground in 26 States: What This Means for Nurse Practitioners 

In the long struggle to gain full practice authority (FPA), nurse practitioners (NPs) can point to notable advances in the last few years. Now, patients in more than half of the states, the District of Columbia, and two U.S. territories have full, direct healthcare access from NPs.

In April 2022, New York and Kansas granted FPA to NPs. That brings to 26 the number of states where NPs can practice to the top of their license without restriction. In this article, we’ll look at how that progress was made, the impact of COVID, and how newly proposed federal legislation would strengthen NP practice. But first, let’s have a look at what FPA means.

Defining FPA

 

“Full practice authority is essentially that the nurse practitioner can practice to the full extent of their education and training,” says April N. Kapu, DNP, APRN, ACNP-BC, FAANP, FCCM, FAAN, president of the American Association of Nurse Practitioners (AANP). “Nurse practitioners are trained to evaluate patients, make diagnoses, order and interpret tests, prescribe medications, coordinate care, and educate. We are educated and trained to do these things,” says Kapu.

In the past few years, the pace has “really picked up as we have seen more and more states move to full practice authority,” according to Kapu. She notes that four states moved to full practice authority through the pandemic: Delaware and Massachusetts in 2021 and New York and Kansas in 2022. “It’s because we demonstrate our commitment to quality and equitable care and ensuring care is provided in all communities.”

In states that have moved to full practice authority, “we’ve seen improved patient care outcomes. We’ve seen an increase in the workforce. We’ve seen an increase in nurse practitioners working in historically underserved urban and rural areas,” Kapu says.

FPA, COVID and Care

While devastating, COVID helped bring to light the high-quality care that NPs provide and boosted efforts to gain FPA. In some states where NPs worked under less than full practice authority, the governors signed executive orders waiving various restrictions, notes Kapu.

“That’s where we saw the opportunity for nurse practitioners to continue providing care. They provided very high-quality care. They were able to provide more accessible care. As you saw throughout the pandemic, they were in communities and churches, going door to door, seeing patients in their homes, and doing everything they did in the hospital and the ICUs. So we demonstrated that continued quality of care. And that is what quickened the momentum during the pandemic; the executive orders provided that opportunity,” Kapu says.

Ohio Experience

In Ohio, a reduced practice state, an emergency authorization during COVID allowed NPs to deliver care via telehealth, notes Evelyn Duffy, DNP, AGPCNP-BC, APRN-NP. However, she notes that NPs can still practice via telehealth, and that ability is no longer contingent on the emergency authorization. Based in Cleveland, Duffy is an NP in the University Hospitals Geriatric Medical Group and a professor at the Frances Payne Bolton School of Nursing.

An NP since 1981, Duffy notes that “we’ve come a long way in Ohio. We got full prescriptive authority at the end of the 1990s.”

However, like all Ohio NPs, Duffy needs a collaborative agreement with a doctor. “Ohio is in the reduced practice category,” she notes. “Not a lot obstructs me from doing what I want. The only thing that gets in the way is having to make that collaborative arrangement.”

Overcoming Obstacles

Kapu stresses the need to get out the message that laws limiting NP practice need to be revised. Laws need to be updated to “allow NPs to practice to the extent of their education and training, not beyond that, but to the extent of their education and training, as they are very capable of doing and have decades and decades of evidence demonstrating their quality-of-care outcomes. So it’s getting that message out that all we have to do is update those laws. It’s no cost or delay and can be put into place, and you would see much-increased access.”

Kapu points to Arizona as an example of what may happen for states that grant FPA. Arizona, she notes, moved to FPA in 2001.  Five years later, the NP workforce doubled, and rural areas saw a 70% increase in NPs.

FPA Federal Legislation

On the federal level, new legislation, the Improving Care and Access to Nurses (ICAN) Act, was introduced in September in the House of Representatives. Supported by the AANP and other major nursing organizations, the act would update Medicare and Medicaid to enable advanced practice nurses to practice to the top of their education and clinical training, according to a press release from the American Nurses Association.

Maintaining Momentum

Although getting FPA in all states has taken a little longer than wanted, “we have momentum,” says Kapu. “I believe we’ll get there, especially with the increasing access to care needs that we’re seeing in the United States today.”

Some of the Many Benefits of Being an NP

Some of the Many Benefits of Being an NP

Between the role’s autonomy and the hours’ flexibility, there’s never been a better time to be a Nurse Practitioner (NP).

What are the advantages of becoming an NP? Unfortunately, we don’t have nearly enough space to list them all, but our sources will give you a good idea of some.

Benefits of Becoming an NP

 

“I believe that nurse practitioners bring a unique perspective to the relationship with our patients. Our educational foundation is rooted in the nursing model, whereas physicians are trained in a more traditional medical model. Nurse practitioners are accustomed to treating the entire patient rather than solely treating a disease or condition,” says Teresa Cyrus, DNP, APRN, FNP-C, co-owner of Integrative Geriatrics, a practice that provides care to underserved adults and seniors in rural Minnesota.

“I believe it is a more holistic approach to patient care. For example, if my patient is being seen for frequent falls, I can visit their home to determine what may be contributing to them. In addition, I will check in with the nursing staff and the patient’s family to get additional perspectives when developing a treatment plan, and then continue to monitor the patient closely after our visit,” she says.

Cyrus, an assistant professor at St. Catherine University in St. Paul, adds that NPs have been filling roles where it’s been more difficult to recruit physicians in geriatrics, family practice, and rural areas. “In the past several years, I have also seen an increase in NPs working as hospitalists, in more nuanced specialty areas, and even as medical directors.”

Role of NP is Changing

In many states, the role of the NP has or is changing.

“NPs’ role and scope of practice have expanded depending on the state where they are licensed to practice. For example, in my state, NPs can practice independently. That means they can own, manage, and operate their clinics without a collaborating physician,” explains Rei Serafica, Ph.D., who is a full-time faculty member at the University of Nevada, Las Vegas School of Nursing and works once a week at an inpatient psychiatric mental health facility in North Las Vegas.

“Some NPs are entrepreneurs, consultants, educators, and even researchers. Some NPs work in academics like me. We are [training] future NPs, and we also manage and balance our careers by devoting a day to practice as NPs to maintain our professional skills and credentials. In other words, it is a dynamic profession that offers flexibility and multiple career opportunities.”

Opportunities for NPs Are Endless

The opportunities seem endless regardless of the type of NP a nurse chooses to become.

“The healthcare system has found relief in employing us in all sectors. NPs are seen everywhere now—from clinics to hospitals and are at the front, cutting-edge of clinical research, faculty, and teaching,” states Isra Hashmi, FNP-BC, who works in private practice. She adds that job security is a big relief because not only are NPs not going anywhere, and their career is only expected to grow.

Nicole Beckmann, Ph.D., APRN, CPNP-PC, embodies the diversity of working as an NP, as she has worked in three different specialties over 15 years of practice.

“[I] find this to be one of the important ways I can continue to grow professionally and challenge my skills. Additional benefits include increased autonomy in decision-making and management of health conditions. Nurses use their holistic approach to patient care to see patients’ health problems in the context of their lifestyles, personal goals, and preferences. In addition, nurses recognize their patients as people, learning each patient’s story, priorities, and unique needs. [We] bring this approach to the patient/provider relationship to diagnose conditions and partner with patients to determine the best treatment options. Patients appreciate this connection and the meaningful relationships they form with their NP providers. This is what makes being a nurse practitioner so satisfying.”

Hours are Long, But Have an Upside

As for hours, NPs may still have to work long hours, but Beckmann explains the upside of it.

“Depending on the work setting of the nurse practitioner, hours may include evening, overnight, or weekend shifts. However, this also means that nurse practitioners can choose a position and work schedule that fits their lifestyle. For example, part-time positions, extended shifts, and block scheduling may allow for long periods off or for the nurse practitioner to have the work/life balance they seek,” she says.

Cyrus says she loves her job, “Being an NP is tremendously rewarding, and I encourage any nurse who expresses interest to pursue that calling.”

Resumes, LinkedIn, and HR Portal Profiles, Oh My!

Resumes, LinkedIn, and HR Portal Profiles, Oh My!

Resumes, LinkedIn, and HR Portal Profiles, Oh My!

 

 

Most nurses at one time or another in their career will want to get hired, get promoted, or get noticed. Besides what everyone has to keep in mind (like how to look for another job without alerting a present employer), nurses have unique considerations when it comes to resumes, online professional profiles (e.g., LinkedIn), and social media usage.

Yet most nurses receive little career development assistance during their nursing school education. Often, the how-tos of resumes and interviewing are covered quickly in a two-hour seminar at the end of their coursework. If they’re lucky, new nurse graduates may get more guidance and training through professional associations or on-the-job mentor relationships. Most likely they won’t. That’s why we asked savvy nurses and career experts for their answers to your resume and profile questions.

Ok, Why Do I Need a Stellar Resume?

Creating a resume can be a major stumbling block for anyone, so it’s easy to give that task short shrift. Some nurses can get away with that, but not when they’re at certain points in their careers. For instance, inexperienced nurses, nurses who are targeting a new specialty, or relocating to a certain geographic area need to bring their “A” game.

When you’re a new nurse graduate…

Kati Kleber, MSN, RN, CCRN-K, a nurse educator and founder of FreshRN, developed an online course on how to get your first nursing job in order to address a pressing need.

 

Resume and Social Media Resources

Kleber sat in on many employment interviews for new graduates and realized that a lot of them “seriously want to do well but shoot themselves in the foot.” She observed that their resumes tend to be generic-looking, with the same coursework, clinicals, and rotations listed. To get around that, she recommends that new nurses highlight what they can uniquely offer, for instance, a willingness to be coached and an eagerness to belong to a strong health care team.

“Clinical experience is important, but you don’t want that to be the only thing you list on your resume, which is a common misconception,” Kleber says. “Nursing students think employers would rather hear all of their clinical experience, but what’s more impactful to a hiring manager is learning about all of the other experiences a potential candidate has—like other employment history, even if it’s not related to health care.”

But what if you don’t have any work experience, even in a somewhat-related field, like food service? “Be proactive; there are a lot of opportunities for nurses to volunteer,” she suggests. “Even if it’s only one five-hour shift a week, that speaks volumes. It says: I can commit and I will show up.”

Polished resume in hand, you can then upload it to an employer’s HR portal or email it, using their preferred method and document format. If applicants don’t follow instructions precisely, it can cause the hiring team “to wonder if they can follow directions or if they can handle the technology that goes along with nursing. If you have to call and ask how to upload a resume, that’s a problem,” warns Kleber.

When you’re transitioning to a competitive specialty…

Not every new nurse comes to the workplace with a blank slate. Some have experience in other fields or nursing specialties and must translate that skill set for a new role. “If you have a background as a teacher, you can be a nurse educator. Business background? Go into a nursing leadership role,” explains Thomas Uzuegbunem, BSN, RN, nurse blogger at NurseMoneyTalk.com and GI nurse in the Oklahoma City area. “The beauty of nursing is that there’s a lot of choice. You can really leverage your nursing degree because of how big the field is.”

Going into a new field or specialty can be personally and financially rewarding, but it takes some strategy to first choose the right specialty, and then to slice and dice previous experience and present it well to a new employment situation.

“You have to show ‘here are the things about me that make me perfect for the job’ and tailor your resume to the job,” says Brittney Wilson, BSN, RN, an informatics expert based in Nashville, Tennessee who owns a popular blog called The Nerdy Nurse.

When Wilson wanted to leave the bedside for a nurse informatics role, she got help from a savvy fellow nurse already employed in that specialty. “I said ‘I’m applying, but I’m not getting any bites.’ He asked to see my resume and critiqued it for free,” she explains. His advice? Use buzzwords, not just general terms, and focus on your skills and qualifications. In Wilson’s case, her qualifications included serving as a technology superuser on her unit, she’d been published, and she had built up an impressive blog which also served as a portfolio.

In addition to getting a resume critique from someone expert in the field, Wilson recommends taking other steps to set yourself apart. Especially if you’re making a transition into a competitive specialty.

“If you’re going from med-surge to cardiac, you have to get more training and education, like through Kati’s [FreshRN] cardiac nurse crash course. Or go to a conference in that specialty,” she says. “You’ve got to prove you’re not just status quo, that you’re willing to go above and beyond for the job. Show the employer ‘I’m putting my money where my mouth is, putting boots on the ground.’”

-When you’re moving to a new geographic area…

There are some areas where it’s easy to find a nursing position and others, such as California, that are much more competitive markets. Nurses may want to relocate for Cali’s sunny surfing beaches, or they may need to relocate in order to follow a coder spouse to Silicon Valley, the technology mecca.

Mac Prichard, founder of Mac’s List, an online career hub for the Pacific Northwest, has helped many new arrivals to a region that’s highly desirable for its creative, laidback lifestyle.

He recommends that nurses be strategic about how they conduct their job search in an unfamiliar city. “First, identify the top five employers and be really specific about where you want to work,” he explains. “Look in business specialty magazines, business directories, and ask your contacts to find the places you want to be. Then, create a list and rank it. You can’t apply everywhere—you’ll exhaust yourself. Don’t be the person doing a ‘spray and pray’ job search.”

Another reason to focus on only a handful of employers is the power of referrals. Candidates are in a much stronger position if they can cite even a weak connection when applying, says Prichard. “People are more likely to hire people they know, like, and trust—or applicants who are referred by people they know who know, like, and trust the applicant,” he says.

It’s not easy to find connections in a town where you don’t know anyone, but it can be done. Search LinkedIn or your alumni directory to see if anyone you know has relocated to that city, or they’re connected to someone who has. Using a six degrees of separation methodology, you can inch your way closer to connections in your target market. Or, be brave and reach out directly to employees at your target employers. Online networking isn’t the only option, either. Pick up the phone and call a friend of a friend or attend a professional conference and arrange to have coffee with nurses in your target city or at your favorite hospitals.

As a long-distance applicant, you may face some hurdles that someone already in the area would not. For instance, employers may prefer local candidates. One way to handle that is to be very direct, advises Prichard.  “Be upfront and say, ‘I plan to move on November 1 and this will be my new home, because I have family there or another connection to the area.’ Otherwise they may think ‘this person is just fishing,’ but if you address it directly, then it becomes a non-issue.”

But what if your resume gets spit out by an applicant tracking system or recruiter that gives preference to locals? “That’s another reason to build connections inside of an organization,” says Prichard. “There are two ways to get a job: through the front door, using the website, the ATS, and a formal hiring process. Or through the back door,” where you rely on personal connections to bypass digital or human screeners.

-When you’re a minority nurse…

There’s an acute shortage of nurses, especially minority nurses, and the unemployment rate overall in health care is extremely low. Yet some candidates experience conscious or unconscious bias based on race, ethnicity, gender, or age. Some research suggests that the name of an applicant is one such signifier.

A recent two-year study showed that companies are more than twice as likely to call applicants who display no racial clues on their job resumes; that applies even to “pro-diversity” employers.

An Asian American applicant named “Lei,” for instance, may substitute the nickname “Luke,” include non-stereotypical hobbies (motorcross and camping), and tweak the names of minority associations, scholarships, and awards.

Whether this type of subterfuge will serve you well once in the interview or result in a job offer is unclear. But the one-third of minority candidates who admit to whitening their resumes rationalize that you can’t get a job offer if you can’t even get your foot in the door for an interview.

Most minority candidates did not scrub their resumes of bias markers, for a variety of reasons, including ethical ones. “Nurses should seek employers that are aligned with their personal and professional values,” says Liz Stokes, JD, MA, RN, director of the American Nurses Association Center for Ethics and Human Rights. Additionally, “Nurses should inquire about diversity initiatives within an organization. These initiatives should promote inclusiveness, civility, and mutual respect, contain methods for reporting violations, and require interventions to avoid recurrence.”

Do I Really Need a LinkedIn Profile?

Keith Carlson, BSN, RN, NC-BC, nurse career coach at NurseKeith.com says he’s often asked why LinkedIn is necessary. His answer? “Your LinkedIn profile is like a resume on steroids.”

According to Carlson, here are a few of the powerful ways LinkedIn can boost your career:

  • You can reach out to people in other places or specialties.

“Say you want to work at Johns Hopkins. You could look up the recruiter or nurse manager or a nurse in the unit where you want to work,” advises Carlson. “Contact the nurse and say ‘Hi, I’d like to meet with you to learn more about your unit and to find out what you’re looking for in an ideal candidate.’”

  • You can be seen by recruiters so you can get job offers.

“LinkedIn is actually a really robust search engine. If you want to be found or you want to find others, be sure your profile is peppered with keywords related to your skills, experience, and expertise,” he says. Additionally, he notes that recruiters may hold back some openings and search LinkedIn for candidates that they then contact directly.

  • LinkedIn has an “Easy Apply” button.

“There are thousands of jobs out there that you can apply for with a click of a button,” Carlson says. Applicants and recruiters both like this option. Strong nurse candidates may be already employed but will still click one button when they wouldn’t otherwise fill out lengthy, tedious online applications.

  • Recommendations are “social proof.”

On LinkedIn, a contact can write you a detailed testimonial, or simply click a button to endorse one or more skills. “To ask for one, say ‘I’m in the job market—would you write me a recommendation?’ Easy endorsement also works as social proof,” says Carlson. “For example, if I’m endorsed 200 times for nursing, someone looking at my profile will think ‘maybe Keith actually does know something about nursing.’ It’s like that saying, ‘100 million Elvis fans can’t be wrong.’”

  • LinkedIn Pulse is an easy way to publish—and get read.

“If you want to be known as a leader, or thought leader, you can publish on LinkedIn’s native publishing platform,” says Carlson. “Say you’re an oncology nurse, write an article about your experiences in that specialty and an employer may read it and say ‘Wow, I want to see this person!’”

How About Social Media? Do I Need to Do That, Too?

LinkedIn doesn’t appeal to every nurse and some experts believe it reflects the needs of employers, not employees, and doesn’t help nurses connect with each other, either. Additionally, many recruiters say they find nurses on Facebook, Instagram, and Snapchat.

If nurses gather on social media and recruiters follow, then it may make sense for a job seeker to do the same. But nurses are also professionals who must use social media appropriately.

What is “appropriate” usage remains a question. “There’s a 60/40 controversy in the nursing community on social media,” says Wilson. “I argue that media has represented us as dumb, ditzy, sexy nurses. So, when you put a bikini shot of yourself with a #nurselife hashtag online, you’re not doing us any favors.”

If you’re not as concerned about the profession’s image, you might consider your own personal brand. “I make a comparison to big companies and how they protect their brands so much,” says Uzuegbunem. “There’s value in that name, that brand. We need to put that same emphasis on our own brands. Corporations invest heavily in creating a brand name and logo and will go to great lengths to prevent that brand from being tarnished.”

And finally, nurses need to use social media appropriately in order to protect their ability to practice. “Nurses must be cognizant of sensitive or potentially damaging information that might be publicly accessible to others,” says Stokes. “Nurses are held to the Code of Ethics and unprofessional conduct, even online, can be subject to negative consequences such as termination or reprimand.”

Protect Your Safety With a Defensive Online Footprint

One of the things that makes nurses nervous about being online, whether it’s social media or an online profile, is personal safety. Transparency may be valued more highly by younger nurses who grew up expecting that anything they shared would be public. Not so for others, such as nurses who want to maintain boundaries between personal and work life, or advanced practice nurses who fear becoming targets for drug-seeking patients.

There are a lot of things nurses can and should do to maintain digital safety, according to social media savvy nurses. “While our entire existence as nurses is to alleviate pain and suffering, there are times when a patient might put our own personal safety at risk,” says Jon Haws, BSN, BS, RN, founder and CEO of NURSING.com, an educational hub for nurses.

The concern for safety needs to begin at the bedside and extend to your online security measures. “As such, I think a couple of very simple measures can keep you generally safe,” says Haws. “Don’t tell patients your last name, don’t mention kids/family/hometown. Keep social profiles private and only accept friendships from known individuals.”

In addition to setting digital profiles to private, you can set up a separate email and phone number for professional use only. There are free options for doing that, such as Gmail and Google Voice.

Taking this kind of approach means you’ll be easy to find for recruiters, but you can ignore unwanted contacts by recruiters, patients, or anyone else you meet up with online.

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