8 Benefits that Could Make or Break Your Job Offer

8 Benefits that Could Make or Break Your Job Offer

There’s nothing like that huge relief when the call from human resources says “You’ve got the job!” After the long application and interview process, you finally feel a sense of accomplishment and you’re ready to just shout, “Yes! I’ll take it!”

But don’t leap at a job just because you have it. An offer is great news, but there’s a lot to consider in a job offer package. At the top of your list is probably the hours you’ll work and how much you’ll get paid for those hours. Salary is, after all, a motivating factor in many job searches and job transitions.

But a job is a package. You’ll be paid a certain amount, but you’ll also get lots of add ons – benefits – that vary greatly from one job to the next.

Before you say yes, consider these job benefits and if they meet your needs. And if you get an offer that falls short on benefits you want, consider negotiating for what’s most important to you.

1. Health Insurance

Health insurance is huge for most employees. Find out exactly what is included in the health insurance you are offered. How much is the premium? Which doctors can you see? What is your deductible? What is the co payment for office visits, emergency room visits, and inpatient and outpatient stays? Does the coverage include any prescription plan? If so, are your medications covered?

2. Health Assistance or Savings

Does the company offer any kind of flexible spending account plan so you can set aside money to be used for healthcare?

3. Dental Insurance

How much is the premium? What kinds of care will the plan cover? If the plan covers routine preventative care like cleanings and xrays, how many is each family member entitled to? Does the plan cover any orthodontic care?

4. Vacation Days

Now frequently just lumped into a “paid days off” group, how many days does that include and will it be enough for you? Three weeks of paid time off sounds great, but if you or a family member you care for has a chronic illness that causes you to miss work more than a couple of times a year, three weeks can easily be consumed. Are you allowed to take unpaid time off?

5. Retirement Benefits

Does the package include any kind of retirement benefits like a 401k plan?

6. Volunteer Hours

If you are an avid volunteer, a company that offers paid time off to volunteer in an organization or a local school might be very attractive to you.

7. Education Plan and Career Development

If you are on track to get a higher degree or are thinking of going back to school, does the company reimburse you for partial or full tuition? Can you take classes that offer professional development or career tips?

8. Company Culture

No, the company culture isn’t listed on a benefits package form, but the company culture makes two similar organizations vastly different. If you like to socialize with your colleagues and find a sense of camaraderie essential to your professional happiness, an organization with company outings, softball teams, or volunteer groups might be worth looking into.

Don’t just take a job based on your paycheck. A good career move offers more than just money in the bank. Your benefits package is as important as your salary and can sometimes add thousands of dollars in value. And if you are close to accepting a job but really want more paid time off, for instance, see if you can negotiate. You might get what you want.

Are Health Centers the Future?

Are Health Centers the Future?

As millions of uninsured people get coverage under the Affordable Care Act (ACA), job opportunities for registered nurses could open up in the nation’s community health centers because many of the newly insured are expected to go there for care. These facilities, also known as federally qualified health centers (FQHCs), provide primary care in medically underserved areas, regardless of patients’ ability to pay. Teams of physicians, nurse practitioners, registered nurses, and other health care workers treat mostly Medicaid patients and the uninsured.

FQHCs, the mainstay of the nation’s health care safety net, have been growing by leaps and bounds in the past decade, posting an 80% increase in new jobs. Now a new wave of patients is expected, fueled by the Medicaid expansion and the new health insurance exchanges, where premiums for low-income people are subsidized.

Planners of the expansion predicted that since many physician practices have limited capacity for new patients, many of these patients would go to FQHCs. Therefore, the ACA set aside billions of dollars in construction funding to help FQHCs expand their facilities so they could handle an onrush of patients.

No one knows, however, how many new patients will come, and the centers, operating under tight budgets, have been holding off on hiring until they get a better idea.

Also, while FQHCs employ a significant number of RNs, these facilities may not appeal to everyone. Salary levels vary widely, with some facilities paying less than hospitals, and many FQHCs are more interested in health care workers with less training, like licensed practical nurses.

What FQHCs Want

Community health centers are looking for nurses who are committed to serving low-income people, usually minorities, says Gary Wiltz, MD, chair of the National Association of Community Health Centers.

“The work should be viewed as a calling,” he says. When Wiltz interviews job applicants for his own FQHC, the Teche Action Clinic in southern Louisiana, he says he wants to see compassion. “The patients are disenfranchised, but many of them have jobs and are working very hard,” he notes. “As a provider, you have to be aware of what they are going through.”

Jennifer Fabre, RN, a nurse practitioner at Teche Action, says nurses are paid less than those who work in hospitals or nursing homes. But Community Health Services, an FQHC in Hartford, Connecticut, pays them comparable rates, according to Valerie Tyson, RN, a nurse at the Connecticut facility.

Tyson says working in a FQHC is very different from the hospital med-surg unit where she used to work. “The hospital has people who are very sick, but here the patients have an acute illness or need follow-up care for a chronic illness,” she says. “This is their primary care stop.”

A big part of the job, she explains, is teaching patients to manage chronic conditions. The RNs also take patients’ calls, routing some of them to doctors or nurse practitioners but taking care of most of them, she adds.

The Connecticut FQHC serves inner-city patients who are mostly Hispanic and black, some sharing Tyson’s roots in Jamaica. Unlike in the hospital, “you get to know these patients over time,” she says. “You develop a relationship with them.”

Fabre added that nurses have to understand their patients’ needs. “You do whatever you need to do to help the patient,” she says. “It doesn’t do patients any good if you prescribe a medication for them and they can’t pay for it.”

Roots in the Civil Rights Era 

FQHCs have a rich history of community service, going back to the Civil Rights era. The oldest rural FQHC, the Delta Health Center, was founded in 1967 in Mound Bayou, Mississippi—the oldest predominantly black settlement in America.

This little village is in the heart of the Mississippi Delta, a land of cotton fields that gave birth to the blues. The health center sits on land once owned by the brother of Confederate president Jefferson Davis, Joseph E. Davis, who encouraged “self-leadership” among his slaves, letting them build a “model community.”

After emancipation, Joseph E. Davis’ former slaves spent two decades earning enough money to purchase the land, founding the village in 1887. Today, Mound Bayou has 687 households and is still almost entirely black. The town came into prominence again in the Civil Rights era of the 1960s, when it caught the eye of H. Jack Geiger, MD, an idealistic Massachusetts physician who wanted to create a new type of health care facility for the poor.

In the 1964 Economic Opportunity Act, the cornerstone of President Lyndon Johnson’s “War on Poverty,” Geiger persuaded President Johnson to include $1.2 million for test sites at Mound Bayou and Boston. Envisioning a self-sustaining community, Geiger and his followers not only built a clinic in Mound Bayou but also dug wells and helped residents improve farming methods.

FQHCs have enjoyed a renaissance in the new century, starting with a wave of new federal funding under President George W. Bush. Patient volume grew by 50%, reaching the 15 million mark in 2006. Under President Obama, the Recovery Act set aside $2 billion in extra funding for FQHCs in 2009, and patient volume then reached 20 million.

The ACA set aside $11 billion for the centers, mostly for construction, to help them build capacity to meet the coverage expansion. The Delta Health Center received $5 million of this funding, allowing for its first significant expansion since it opened 47 years ago.

The new building will open in February. “We’re going to have brand-new rooms and new equipment,” says Neuaviska Stidhum, RN, the chief operating officer at Delta. “It means we’ll be able to see more patients.”

Centers Holding off on Hiring 

But even as Delta and many other FQHCs expand, they are holding off on hiring more staff and even, in some cases, opening some of their new projects. Facilities have to be careful about hiring because the new federal funding does not cover operational expenses. Teche Action Clinic, Wiltz’s FQHC in Louisiana, renovated two new sites using federal money, but it doesn’t have the funds to open them.

Moreover, there are signs that the anticipated onrush of new patients may not be as large as expected. Half of the states, including Mississippi and Louisiana, aren’t participating in the Medicaid expansion. Technical problems with exchange websites are dissuading some people from signing up, and the fine for not obtaining coverage may initially be too low to force some people to buy insurance.

Stidhum adds that many doctors’ offices in the Delta region still have a lot of capacity, so there would be less reason for the newly insured patients to use her FQHC. “We don’t know what we’ll do yet, “said Stidhum when asked about hiring. “Maybe we’ll need more staff, or maybe we’ll just need to shift their duties around.”

The story is different in Connecticut, which has joined the Medicaid expansion and has a very active insurance exchange. Tyson says her Hartford FQHC has put off hiring, but she is optimistic about hiring in the future. “The center is really busy,” she says. “If there are more patients, we would have to hire more nurses.”


Nurses as “Champions of Coverage”: Part 2

Nurses as “Champions of Coverage”: Part 2

Today, October 1st, is the beginning of enrollment in online health insurance marketplaces nationwide. The exchanges are at the center of the Affordable Care Act (or Obamacare), the largest healthcare expansion this country has seen in nearly half a century.

Demand in this first day of the six-month open-enrollment period has been incredible, overwhelming some systems, inspite of the battle on Capital Hill over the debt ceiling and implementaion of the health care overhaul.

Nurses have a major role to play in educating patients about coverage options and enrollment. Though you may not have much experience talking to patients and community members about insurance, think of it as another aspect of health care education.

How Nurses Can Champion Coverage

  • Educate yourself first by downloading a “fast facts” toolkit that includes handouts, fact sheets, and brochures. Or you can watch videos or view PowerPoint presentations until you feel comfortable answering patient questions about enrolling for coverage.

For the ACA Toolkit, click here.

For Marketplace Training Resources, click here.

  • Share what you find out with others – most of these resources are available online, through text messages, emails, and toll-free phone calls. (In English and Spanish, too.) You can also help patients sign up for coverage. And don’t forget to spread the word to others at work, during nursing rounds, say, or other types of educational sessions.

Online: Healthcare.gov or CuidadoDeSalud.gov  (texts and emails available, too)

24/7 Consumer Call Center: 800-318-2596 (available in 150 languages!)

Social Media in English and Spanish:

    • Facebook.com/HealthCare.gov
    • Facebook.com/CuidadoDeSalud.gov
    • @HealthCareGov
    • @CuidadoDeSalud

How are you taking the charge in alerting uninsured or underinsured patients about coverage under the Affordable Care Act? We’d love to hear what’s working for you!


Jebra Turner is a health reporter and former H.R. director, where she oversaw workplace health and safety training programs for staff and clients. She lives in Portland, Oregon, but you can visit her online at www.jebra.com.