Looking for a job? Before applying for a new position, examine your social media profile.
Make sure that what you find will help and not hinder your opportunity with a prospective employer. If your public face is unflattering, clean it up. Failure to do so may cost you a coveted position. Employers are increasingly searching social media sites to look for potential hires with a professional image and good qualifications. Anything less and you may be rejected on the spot.
In a survey by CareerBuilder of some 2,100 hiring managers and human resource professionals, 43% rejected job applicants as a result of what they found on social media sites. Some of the reasons they said that knocked candidates out of the running for jobs include sharing racy or inappropriate photos (50%), poor communication skills (30%), bad-mouthing a previous employer (33%), and, discriminatory remarks relating to race, gender or religion (28%).
On the flip side social media gave some prospective employees an edge. One out of five respondents found social media information that led them to hire a candidate. At least half of the respondents said the profiles conveyed a professional image, revealed a well-rounded candidate and supported the candidate’s qualifications.
The 2013 survey found more employers are using social media to weed out candidates compared to last year.
Make sure your online persona reveals positive clues about your character, image and personality. Keep your social media presence positive by taking these steps:
•Search yourself. Google your name and check out other sites. Clean up any digital dirt.
•Update your LinkedIn profile and make sure it is accurate.
•Check your privacy settings regularly as they may change. Never post anything that would be unsuitable on the front page of a newspaper.
•Consider creating a profile that is strictly for business.
•Use good grammar. When commenting online, avoid typos and keep the content clean.
•Avoid ranting about an employer and co-workers.
•Post content that shows you are sociable and well-rounded.
As more health care employers continue to streamline their staffing and management process in an effort to control costs, it is becoming increasingly difficult for minority nurses to advance to high-level nursing positions. Nurses who hope to move up to a more advanced career level often have no choice but to change employers and/or relocate to other cities.
Whether you’re moving across the country or across the street—or, for that matter, if you’re a brand new nursing school graduate taking that crucial first step from classroom to career—adjusting to a new job can be stressful. At the same time, health care employers face the considerable challenge of how to orient and train newly hired nurses as quickly as possible to minimize “downtime” in patient care while the new staff members are getting up to speed with the facility’s specific policies and procedures.
Preceptorship programs—i.e., training programs that pair new nursing staff with experienced nurses at the facility—can be an effective solution for both the employer and the new employee. Preceptorships are organized, planned educational programs in which seasoned nurse preceptors, in addition to their regular nursing functions, promote the integration of newly hired nurses into the workplace, helping them make a smooth transition into a fast-paced, hands-on patient care environment.
As of the year 2000, minority nurses still make up only about 13% of this country’s total RN population. Therefore, there is a strong chance that a newly hired nurse of color could be the only nurse from his or her particular racial or ethnic background at that facility. How will they be able to fit into the work environment when none of the other nurses look like them or understand their culture?
It helps to have a friend. Effectively managed preceptorship programs can help minority nurses adjust quickly and confidently to their new job responsibilities by giving them an immediate friend—a knowledgeable, skilled nurse to show them the ropes and help them cope with the challenge of being “the new kid on the block.”
To Guide, Support and Assist
Picture this scenario: You’ve just found out that you’ve been hired for the nursing position of your dreams, but it’s at a new hospital where you know no one. How would you feel? Panicked? Apprehensive? Anxious? While these feelings are natural with any major life change, imagine how much calmer you would feel knowing there would be someone at your new job to guide, support and assist you when you join the organization.
A well-planned preceptorship program and knowledgeable, helpful preceptors are key factors in building a great nursing team. A preceptor must be a clinically experienced, competent and skilled nurse who can serve as a role model for the new employee. Ideally, the preceptor’s role is to guide, train and assess the new nurse to ensure that he or she will be able to function effectively, both independently and as a team member.
An important element of any successful preceptorship program is providing planned social activities that can serve as a catalyst for helping recently hired nurses get to know their new colleagues. These events are an opportunity for staff members to meet and welcome their new co-workers, and to identify common interests and goals. For new minority hires, this type of socialization can also be a helpful way to build working relationships and get to meet and network with other nurses of color.
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Employee retention is important in maintaining a stable patient care environment at any health care facility. Vast amounts of time and money are invested each year in recruiting and training new nursing staff; the same amount of energy should be put into retaining these nurses once they are hired. Preceptorship programs are an integral part of retention, because they give each new nurse an opportunity to learn, grow and contribute to the organization.
When newly hired RNs are treated with value and respect, when trust and a positive work environment are established right from the start, word of mouth will spread. Building a strong reputation as a supportive workplace for minority nurses ultimately benefits both retention and recruitment, by encouraging other RNs of color to apply for nursing positions at that facility.
“Would I Want You as My Nurse?”
Once the preceptor and the preceptee have begun their training relationship, assessing the new nurse’s progress and clinical performance becomes a pivotal component of the program. As an experienced nurse and supervisor, the question I always pose when evaluating nursing recruits is: “Would I want this person to take care of me or my family members?”
Because the preceptor works side-by-side with the new hire for a length of time determined by the organization and the individual’s specialty, they are in the perfect position to evaluate the new nurse’s abilities. The preceptor’s role in this phase is not to demean or belittle the new hire, but to serve as a conduit to facilitate their growth and development as a nurse. While there may be times when the preceptor and the new nurse may not agree on certain areas of the skills assessment, the bottom line is that whatever decision is agreed upon must always be in the best interests of the patient.
Because the newly hired nurse will soon be required to work independently, his or her competence must be validated as soon as possible. The preceptor’s responsibility is to do everything possible to ensure that the new staff member will be able to function effectively as a valuable member of the nursing team. Nurses are taught many processes and skills, but the standard mission should always be the same—to provide safe, high- quality nursing care.
Watching Them Blossom
Preceptorship programs are a management initiative with a proven track record in assisting both novice nursing staff and those moving up to the next rung of their career ladder. Any health care facility that does not have such a program in place can benefit tremendously from starting one.
Guiding a new nurse and being able to watch him or her blossom is a gratifying experience. Minority RNs who are nursing department managers, supervisors or simply experienced staff members have many opportunities to reach out and assist new nurses entering their workplace. It is imperative that you extend a nurturing hand to your peers—especially to other minority nurses who may be overlooked by majority co-workers. By becoming a preceptor and “giving back” to a new minority nurse, you may even find that your own professional development is growing and blooming too.
Many job seekers miss out on an opportunity to increase their salary and benefits, due to their lack of understanding of, and preparation for, the negotiation process. Unlike some career fields where salary negotiation has been impacted negatively by the poor job market, the salary negotiation prospects for those entering high-demand positions within the allied health field are still good. But as with all aspects of the job search, preparation is key. Successful salary negotiation requires self-assessment, research, planning and strong communication skills. Careful preparation will increase your ability to create a mutually satisfying agreement between you and your potential employer.
The following steps will help you prepare for the salary negotiation process. Just remember that the topic of salary should never be addressed until the employer brings it up. And the actual process of negotiation shouldn’t begin until you have received an offer of employment.
Self-Assessment: Prioritize Your Needs
The first step in preparing to negotiate your salary and benefits is to clarify and prioritize what is important to you. This is necessary because your needs will influence all aspects of the negotiation process. When considering a job offer you’ll need to know what your priorities are in order to decide the value of the offer and what aspects you may want to negotiate.
There are many potential benefits to consider in addition to base salary when accepting a job offer. These benefits increase the monetary value of your base salary, in addition to adding quality to your work life. Depending on your priorities, you’ll want to consider various benefit areas when preparing to negotiate.
For example, if you value learning about new developments and opportunities for advancement in your field, continuing education should be an essential part of your compensation package. You may be able to negotiate reimbursement for renewal of certifications, subscriptions to professional journals, and/or tuition reimbursement for an advanced degree or continuing education courses.
Perhaps you are concerned about having ample opportunity for professional development. In this case, you could negotiate for payment of membership fees for professional associations, conference registration fees, or subscriptions to professional publications.
If you have children or are considering starting a family in the near future, the ability to balance your work and personal life will be important. You’ll want the opportunity to increase your vacation time, arrange for flexible work assignments, obtain reimbursement for child-care costs, and extend benefits coverage to family members.
Another subject you might be able to negotiate is your performance review. Some employers will grant a shorter time period before your first review, thereby giving you the opportunity to discuss a salary increase and advancement opportunities earlier than usual. Finally, if you’re really fortunate, you might even be able to get the employer’s assistance in repaying your student loans.
Take time to review and consider your priorities. Knowing your main concerns ahead of time will help you present yourself to your employer with composure and conviction. In addition, you will be prepared to compromise benefits of a lesser value in exchange for benefits that are more beneficial to you.
Self-Assessment: Know What You Have to Offer
Another step in preparing to negotiate is understanding your intrinsic value. What do you have to offer an employer in terms of your knowledge, education, skills and experience? You need to assess these areas to identify your strengths.
During the negotiation process you will present these strengths to explain your value to a potential employer. The strengths you choose to emphasize during the negotiation will depend on the needs of the employer. Understanding the employer’s needs can be difficult when you are thinking about your own priorities, nonetheless, it’s important to put yourself in the employer’s shoes. When you understand the priorities of the employer and the organization, you’ll be able to relate to the employer’s priorities and tailor your needs to the employer’s frame of reference. Your goal is to utilize this knowledge to create a mutually satisfying outcome to the negotiation.
Research: Understanding Your Market Value
When it comes to attaining the best possible base salary, you will need to do your homework ahead of time in order to discover your market value. This means identifying the current salary range offered for the position you are seeking.
There are various resources to access this information, many of which are available on the Internet. See the sidebar “Bookmark These Sites!” for further information on useful Web sites.
Utilizing the services of allied health professional associations or societies is a vital component of your career development process and many of these organizations provide salary data. Trade journals can also be good sources of salary information.
Planning: Negotiation Strategies
The best time to enter salary negotiations is when you have been offered the position and before you have fully accepted it. This is the time when you will have the most negotiating power. By that point you will have assessed your priorities, market value and needs of your potential employer. But before you enter into any negotiation, you will need to create a plan for a dialogue that addresses your concerns and creates an amiable negotiation. A useful strategy to focus the discussion on areas that you’re interested in is to use exploratory questions.
For example, an interviewee with a few years of laboratory tech experience may be interested in a promotion to a supervisory position. During the course of the discussion the interviewee could ask, “What is the opportunity for advancement into a management or supervisory position?” This question opens up the discussion on the requirements for this position and opportunities for receiving additional training. It also sends a clear message to the employer that this candidate is serious about a career and not just looking for just another job.
An interviewee just out of college may be interested in continuing his or her education. In this case the interviewee could ask, “Can we explore the possibility of reimbursement for an advanced degree?”
Always maintain proper etiquette during the negotiation process. One of the best ways to do this is by putting your requests in the form of questions, rather than stating your demands. This is especially important for entry-level interviewees; aggressive, inexperienced candidates turn off most interviewers. On the other hand, a candidate who is perceived as polite but inquisitive will often be viewed in a positive light. For examples of how to properly start off such questions, see the sidebar, “Exploratory Questions”. As you discuss and explore the possibilities during negotiation, it is important to remain flexible in your questions and responses. When you are asked a question, never respond with a flat “no,” instead pause, consider the question and then respond. Remember you can’t get what you do not ask for.
When answering questions regarding salary, it is best to give a range because it allows flexibility during the negotiation. You want to find a salary that will satisfy both you and your potential employer. If you have done your homework, you’ll be able to provide a range based on your research to identify the market value for the position and an estimate of your intrinsic value based on your unique skills and experience. You need to decide what is the highest you are worth within that range and what is the lowest you will accept. To support your request, you can bring salary information from your research to the negotiation.
According to David Soprych, regional recruiter for HCR Manorcare, in Aurora, Ill., “Salaries are typically set for staffing levels at large organizations. Smaller organizations have more flexibility in salary. Also, for management positions there is greater flexibility for base salary.” In any case, you will have to sell your skills and accomplishments when negotiating your salary.
Another area that has received media attention is sign-on bonuses. Soprych cautions job seekers to be wary of large sign-on bonuses. “This could be a red flag that the organization is having difficulty keeping and finding employees,” he says. “Also, a company may provide a top salary but poor benefits or a moderate salary with excellent benefits. It is in your best interest to investigate these organizations carefully.”
Communication Skills: The Art of Diplomacy
Successful negotiations are built on developing rapport and trust. By applying active listening, strong communication and keen observation skills, you will be able to present yourself well and respond to various situations in an appropriate manner. Listen carefully and pay attention to the employer’s attitude, words and body language. You are looking for positive reactions to your statements; your goal is to create a positive and friendly atmosphere. This is very important when you are trying to reach a mutually satisfying outcome.
Because your emotions will be running high during the negotiation, it is helpful to rehearse your presentation with another person prior to your interview. This will prepare you for answering questions and allow you to receive feedback on your style of communication and the logic of your presentation. Through preparation and practice, you’ll increase your confidence and ability to handle the negotiation process.
Don’t miss out on an opportunity to negotiate a great offer. Take time to prepare and you’ll be able to negotiate an offer that is mutually satisfying for you and your potential employer.
Exploratory Questions
During the negotiation, you will want to steer the conversation towards points of negotiation that interest you most. Here is a list of appropriate introductions to such questions.
1. What is the opportunity for…?
2. Are you willing to…?
3. What would you consider…?
4. Can we talk about…?
5. What are the alternatives to…?
6. Have you considered…?
7. Can we explore the possibility of…?
8. Is there anything you might be able to do about…?
9. What if…?
10. Would you think about…?
Bookmark These Sites!
The following Internet sites are helpful for researching your appropriate base salary ranges.
www.salary.com Provides information on salaries searchable by profession and geographic location. Keep in mind that salaries for identical positions vary depending on geographic location and years of experience.
www.jobstar.org Lists salary surveys with links to other occupational salary sites.
www.bls.gov The Occupational Outlook Handbook offers consolidated salary figures for specific occupations.
www.medzilla.com/survey Provides salary information for various health professions based on degree level and years of experience but does not list by geographic area.
If you’re looking for a new nursing job (or your first), you might think heading to the nearest city is your best bet–lots of people needing lots of nursing care, right? Or maybe you’re considering rural areas–with everyone concentrated in cities, they must need nurses desperately in the country! The truth is, no matter where you live, nurses are vital for healthy communities. From the quiet countryside to bustling urban centers and everywhere in between, nurses are at work in hospitals, clinics, physicians’ offices, and many other health care settings. Though nurses have felt the effects of the economic downturn (a tight job market coupled with fewer nurses retiring), experts predict the future holds nothing but opportunity for those who weather the storm.
Ready to Make a Move? Nursing is a portable profession, and nurses can relocate with relative ease. But whether you want to experience a different climate, live closer to family and friends, or just want to try a new city, it’s smart to plan ahead. Cheryl Palmer, a certified career coach based in the Atlanta area, offers these tips: Weigh the Costs: Not all job seekers look at the cost of living before they decide to move for an opportunity, and a significant jump in everyday living expenses can come as a shock to you–and your bank account. “While $80,000 may be an excellent salary in one location, it might not be so great in another,” Palmer says. “Job seekers need to compare their current standard of living in their current location with what it takes to live in another part of the country.” Research the cost of living in various areas using the calculator at www.bestplaces.net/COL.Do Your Homework: “I don’t recommend moving and then job hunting unless the nurse has already researched the area and knows that opportunities are plentiful in the new location,” Palmer says. “It certainly was the case up until a few years ago that a nurse could move anywhere and find a job, but that’s no longer true, especially not for new graduates.” Network From Afar: Networking is perhaps the most effective job search strategy. Palmer says the best job opportunities are not always advertised, and even if they are, hiring managers often already have someone in mind for that opportunity. She recommends using social media to identify health care organizations in different cities and then locate contacts at these organizations that nurses can network with online. Persistence Pays: Palmer notes that many employers look at local candidates first. “Don’t get discouraged if you don’t get a huge response to the résumés that you send out,” she says. “Be persistent. If you are willing to relocate at your own expense, you can say so in your cover letter. Because of the recession, many nurses who ordinarily would have retired have not, so the competition is stiffer now than it was prior to the recession.”
Which nursing specialties offer the most opportunities? And in which areas of the country can minority nurses make the largest impact? Though the job market continues its slow creep toward recovery, it’s still an excellent time to explore burgeoning nursing specialties and areas of the country that need skilled nurses. As the country emerges from the recession, nurses will be in demand everywhere, so it’s simply a matter of geographical preference.
“We are on the brink of a very significant nursing shortage, so any tight job market we’re seeing right now is probably going to change on a dime in the next several years,” says Donna Cardillo, M.A., R.N., nursing career specialist, author of A Daybook for Beginning Nurses, and “Dear Donna” columnist for Nurse.com (www.nurse.com).
Nancy Pokorny, M.S., R.N., a nursing career specialist at Albert Einstein Healthcare Network in Philadelphia, Pennsylvania, says she hopes the current job market won’t discourage people from going into nursing or staying in the profession, because an impending nurse shortage is real, even though it’s not evident at this time. “Certainly everyone is hoping for an economic resurgence, but people still need to pursue nursing as a career,” Pokorny says.
Despite the current bleak job market, the Bureau of Labor Statistics’ (BLS) 2010–2011 Occupational Outlook expects job opportunities for registered nurses to be excellent, with job growth much faster than the average for all other industries. The BLS reports that hundreds of thousands of new nursing job openings will emerge from the need to replace retiring nurses in the years to come. Employment is expected to grow by 22% between 2008–2018.
“Right now the demand for nurses is lower, and I think that is a result of the bad economy and folks that would normally be retiring waiting to retire,” says Darlene Curley, R.N., M.S., Executive Director of the Jonas Center for Nursing Excellence, a foundation that works to increase ethnic and racial diversity among the nursing workforce. “I think for the next two to five years there will be fewer opportunities for initial employment in the specific areas that a nurse may want to go into when they graduate. However, I think that a nurse that comes from a diverse background will have more opportunities because employers will need to have those nurses to be able to provide the best care for the patients.”
A nationwide nursing outlook
“Nursing is very portable–more portable than most careers,” Cardillo notes. This means that a nurse can choose to live and work anywhere, though some areas offer more opportunities than others.
The Northeast region of the United States has the highest overall concentration of registered nurses; specifically, Massachusetts, Rhode Island, and Delaware rank in the top five states for nurses. South Dakota in the Midwest and Mississippi in the South are also in the top five for a high concentration of RNs (Source: Bureau of Labor Statistics.See sidebar for more info).
The Northeast also scores big for annual mean wages, with Massachusetts, Maryland, and New Jersey ranging from the mid-$70,000s to low $80,000s. In the West, Hawaii and California rank in the top five for nursing salaries, both in the low to mid-$80,000s, according to the Bureau of Labor Statistics.
Cardillo says she doesn’t consider any area of the country a “hot spot” for nurses right now, but, “for the most part, there are opportunities everywhere, and typically you’ve got a proportionate number of nurses to job opportunities, so I don’t know that anybody needs to necessarily relocate in order to find what they’re looking for,” she says. The great thing about nursing is there are opportunities all across the country, so sometimes nurses can do some travel nursing–work for a travel nurse agency to try out different areas, experience different geographic locations, and work in different specialties for different employers. That’s maybe a way to try different things out.”
“The demand in nursing is strong enough that it transcends race, gender, and nationality. Minority nurses are needed in all areas, regardless of rural or urban settings,” says Jill Jarufe, M.B.A., a nursing practice search consultant at Kaye/Bassman International Corporation, a recruiting firm based in Dallas, Texas.
Jarufe agrees that the general future job outlook for nurses in all regions is outstanding and is only expected to continue to grow over the next 10 years, but she points out that warmer climates in the Southeast and Southwest are generally showing the most opportunities for growth, as the baby boomer generation tends to relocate to these areas.
Rural versus urban areas
Minority nurses come from a variety of geographic areas and often feel a strong desire to give back to their communities by working within them. Nurses in rural areas can help people who often have limited access to high-quality health care–then again, they can head to more urban areas and find the same problem. The need for nurses is widespread and growing, so no matter where you chose to practice, you’ll make a difference. Of course, nurses must consider many factors when deciding where to work, including the number of potential job opportunities, cost of living, personal preferences (e.g. city versus suburban or rural areas), and where their passion lies within the health care arena.
Dollars and Sense National salary ranges for nurse practitioners by industry: Health Care: $68,076–$87,376 Family Medicine: $68,458–$87,107 Hospital: $68,213–$87,804 Medical Services: $68,105–$88,356 Medical Office: $68,371–$87,411 Source: Payscale.com, www.payscale.com/research/US/Job=Nurse_Practitioner_(NP)/Salary
“We have a responsibility toward our own community, first and foremost,” says Adrian Juarez, B.S.N., M.S.N. “Go out there and get yourself the training and skills that you need and then give back to the community that’s given so much to you. Never forget where you’re from.” For some minority nurses, that means going to work for an organization like the Indian Health Service, focusing on American Indian and Alaska Native tribes. For other nurses it means working in inner cities or rural areas that suffer from health disparities and lack access to quality care.
Missy Gilford, B.S.N., R.T. (R), Assistant Manager of Emergency Nursing at Children’s Healthcare of Atlanta at Hughes Spalding in Georgia, has been a nurse in the area for 15 years. “The area that I work in is in downtown Atlanta. Most of our patients are minorities. In our emergency room we see 4,000 or more patients per month, and the majority of them are minorities. I would say about 85% are minorities.”
Juarez has firsthand experience working as a nurse in various regions of the country, including his home state of Texas. He’s also worked as a nurse in Los Angeles and California, and he is currently pursuing his doctorate in nursing at New York University on a Jonas Center scholarship, focusing his research on addressing the lack of access to health care for marginalized populations. He describes the quality of life on the East Coast as one of the best in his experience.
“Here, at least in the New York City metro area, there’s a strong economy and there’s always opportunity and potential for a job,” Juarez says. “You have public transportation to get to your job and high-quality schools. I would have to say that Southern California has a higher quality of life as well, though not as high as the East Coast [in my opinion]. But in the West and Southwest where I’m from, one of our biggest issues is a basic need like water, so there is definitely a difference there.”
Upon completing his degree at New York University, Juarez says he plans to return to his roots and work in Texas. With his doctorate in hand and high level of commitment to give back to his community, he will be a welcomed asset. “There’s definitely a need for advanced practice nurses in rural areas where there is often a shortage of physicians,” Cardillo says. “Advanced practice nurses are taking on a bigger role in many rural areas.”
The staggering shortage of physicians in rural areas often drives the need for advanced practice nurses. Only 10% of physicians work in rural areas, compared to 90% in urban areas.1 Nurses, particularly minority nurses, are needed to fill these gaps in the availability of primary care practitioners.
While the coasts always draw large numbers of people, nurses shouldn’t overlook the Midwest. “The Midwest has some great opportunities also; there isn’t any particular decline out there,” Cardillo says. “In fact many hospitals in the Midwest are hiring and there’s good quality of living. I was in Illinois recently and there seems to be a lot happening there [in health care]–in the Chicago area certainly.”
Advanced practice nurses fill the gap
With such a bright future forecasted for nurses nationwide, there are several areas of nursing that experts agree are destined for strong growth–and the need for minority nurses in these specialties is crucial for delivering culturally competent patient care.
Cardillo highlights one nursing opportunity in particular: advanced practice nursing (APN), which includes certified registered nurse anesthetists, certified nurse midwives, clinical nurse specialists, and nurse practitioners. APNs hold master’s degrees in their field of concentration and are licensed to perform assessments and prescribe medications to patients.
“Nurse practitioners work under the advisement of a physician, but they are really independent practitioners. This is really a huge growth area and is related to health care reform since one of the components of health care reform legislation is the increased need for primary care [providers],” Cardillo says. That need is ever-present for minority patients who sometimes have limited or no access to physicians. Nurse practitioners are not only more accessible and affordable in facilities such as pharmacy clinics, but Cardillo says patients often feel more comfortable seeing a nurse than a physician.
“Advanced practice nurses are filling the gap in primary health care and becoming major providers of primary care” Cardillo says. “In some cases it’s because of a shortage of primary care physicians, but also, there’s a growing body of research that shows that advanced practice nurses are providing high-quality care at a more reasonable price. Also, we’ve long known that the health care consumer has a high degree of trust in nurses and is very comfortable being treated by nurses and talking to nurses–sometimes more so than they are with physicians. That’s not an anti-physician statement; it’s just the nature of what’s happening out there.”
Pokorny agrees that the greatest growth lies in advanced practice nursing. “That doesn’t help the new graduates coming out the door with their bachelor’s degrees, but advanced practice nursing is definitely growing. It looks like the government is putting the educational dollars into it with the changes in health care coming upon us quickly. Primary care, nurse-run centers–that’s really going to be the key,” she says.
Critical needs
In addition to advanced practice nurses, critical care nurses (ICU, ER, operating room, recovery room, etc.) remain and will always be in high demand across the country. “In fact, some people speculate that hospitals will eventually be one giant intensive care unit, as we continue to find alternate ways to treat people outside of the hospitals,” Cardillo says.
Another growth area is outpatient nursing or ambulatory care nursing, which Cardillo says is “growing by leaps and bounds because we are delivering much more care outside of the hospital. Ambulatory care nursing is a term that encompasses many different practice settings to include any outpatient services, and it also includes tele-health or tele-nursing where nurses are giving advice via telephone or doing telephone triage. I consider it a sub-specialty of ambulatory care nursing. Some consider it tele-nursing.”
Show Me the MoneyStates with the highest concentration of registered nurses annual mean wage: South Dakota: $53,520 Massachusetts: $81,780 Mississippi: $57,630 Rhode Island: $68,830 Delaware: $70,770 States with highest annual mean wage for registered nurses: California: $85,080 Massachusetts: $81,780 Hawaii: $80,020 Maryland: $76,330 New Jersey: $74,990 Source: United States Department of Labor, Bureau of Labor Statistics, Occupational Employment and Wages, May 2009, www.bls.gov/oes
Many nurses only think of more traditional clinical roles, but Cardillo urges them to consider some of the non-traditional nursing careers showing strong growth. “I have a very broad view of who a nurse is and what a nurse does,” she says. “So I would say one nursing non-traditional growth area is nursing informatics–nurses combining their clinical knowledge with computer science. Computers are being used in increasing ways in health care, and that’s a very exciting, hot growing field right now for nurses.”
Another field worth investigating is forensic nursing, a combination of the legal arena and nursing science. Forensic nursing is also an umbrella term encompassing specialties such as sexual assault nurse examiner, nurse investigator, and nurses who work with patients of suspected elder or child abuse.
If you see yourself in a more advanced nursing role, now might be the perfect opportunity to get the education required for these growth specialties. While nurses can take a number of educational roads, from associate degrees to graduate-level studies, the fastest growing specialties (such as nurse practitioner) require a master’s degree. It’s a really good opportunity for individuals who are currently practicing nurses to jump back into the educational waters and get back to school for advanced practice positions or nurse educator positions, because certainly faculty is needed,” Pokorny says.
Finally, for nurses with a flare for business, another area to consider is entrepreneurship. “First of all, nurses make great entrepreneurs. There’s great opportunities for them to do things independently, to do education, CPR training, open adult day centers, child daycare centers–there’s a whole host of things. For example, I heard about some new grad nurses who couldn’t find a traditional job because of the current tight job market, so they opened a sick child daycare center. And what a great idea that is. How innovative. And who better than nurses to operate such a center?” Cardillo says.
Whatever road you decide to take and no matter where it leads you, one thing is certain: minority nurses are needed everywhere in order to deliver the best culturally competent patient care possible. “Nurses are multi-talented and versatile,” Cardillo says. “There are many ways and places to make a difference. There’s no one right path for every nurse to follow. Each individual nurse has different interests, different backgrounds. Nurses really need to follow their heart in nursing and carve out their own path. Many people will tell you that this is the way you have to start in nursing; this is the way you have to build your career in nursing. But there is no right way. We’re all different. The opportunities are endless. There are many different things we can do, so you really have to follow your heart and make it work for you.”
References:
1. Rural Healthy People 2010. “Healthy People 2010: A Companion Document for Rural Areas,”www.srph.tamhsc.edu/centers/rhp2010.
Do you dream of a nursing position that offers constant variety, instead of treating the same types of patients and medical conditions day in and day out? Do you long for a work environment where physicians regard you as a key player on the team, rather than making you feel subservient? Have you always wanted to work in a field where the patients come from so many different walks of life that a racially, ethnically and culturally diverse nursing staff is nothing short of an absolute necessity?
“I enjoy the variety,” enthuses Julie Moses, RN, a native of Trinidad who is a clinical resource nurse in the emergency department at Washington Hospital Center in Washington, D.C. “Any medical problem can turn up in the emergency room. You get to do so many different types of nursing—from med/surg, OB and orthopedic to cardiac care and ICU. You see it all, from birth to dying, and everything in between. I just love it!”
Thelma Kuska, BSN, RN, a Filipino-American CEN (Certified Emergency Nurse) who worked for 20 years in the ER at Christ Hospital in Oak Lawn, Ill., believes emergency nursing is an ideal career for minority nurses because it is so empowering. “I’ve worked in other areas, such as surgery and pediatrics,” she says, “but the ER is the most rewarding, because the doctors treat you as a colleague. They value your input. If you say, ‘I need you here in this room, NOW,’ they run. And they show you everything—they’ll say, ‘Come look at the x-ray!’ instead of treating you like someone who’s just there to follow orders.”
Because life-threatening emergencies cut across all categories of age, gender, race, ethnicity and socioeconomic status, emergency nursing is virtually synonymous with diversity. And because the nurse is usually the first person that patients encounter when they are brought into the ER, minority nurses can play a unique and highly visible role in providing culturally sensitive emergency care.
“We’re really right there on the front lines,” notes Cherrlyn Jones, MSN, RN, an African-American clinical resource nurse at Howard University Hospital in Washington, D.C., and president of the Metropolitan Washington Chapter of the Emergency Nurses Association (ENA). “The way the patients see us shapes the way they will view the rest of their treatment.”
“There’s always anxiety in the ER, because patients don’t come there unless something is really wrong,” adds emergency nurse practitioner Elda Ramirez, MSN, RN, CEN, FNP, who is also an assistant professor of clinical nursing at the University of Texas-Houston School of Nursing. “It’s important to give them some sense of relief and comfort. I think that when minority patients see a caregiver from their same culture, it gives them that relief. They think, ‘This person will understand me. They will know what my problem is.’”
Best of all, job opportunities for emergency nurses are everywhere, because the demand for these professionals has risen to unprecedented levels in recent years. While America is currently suffering from an acute nursing shortage in virtually every area of the profession, RNs with specialized emergency-care training, skills and experience have become particularly scarce.
Beyond “ER”
If your knowledge of emergency nursing is based on watching the TV show “ER,” it’s time to switch to the reality channel. “I think the words ‘ER’ may scare some potential nurses away,” Moses believes. “They say, ‘I don’t want to work [in an environment] like that!’ But emergency nursing is simply another type of nursing, another way to care for people. It’s not like the TV show, where everybody is constantly rushing around.”
In fact, the term “emergency room” no longer truly reflects reality. The Emergency Nurses Association, along with a growing number of hospitals, prefers the more all-encompassing term “emergency department (ED).” Today’s emergency nurses can be found practicing in an impressively wide array of settings beyond the traditional ER—from trauma centers, urgent care clinics and prehospital services to such enterprising new areas as in-flight nursing, forensics, amusement park nursing and emergency prevention education. The ENA’s membership ranges from staff nurses, ED nurse managers, administrators and clinical nurse specialists to prehospital coordinators, nurse practitioners and educators.
Kuska now works as an injury control and prevention educator for the National Highway Traffic Safety Administration, providing outreach to communities in a six-state region. She teaches the importance of seatbelt and airbag use, bicycle safety and drunk-driving prevention. “I did a lot of soul-searching about whether I was ready to give up ER nursing,” she says. “But I finally decided that with this position, I could use my expertise to make a much broader impact than I could treating just one patient at a time.”
Still other emergency nurses are expanding their careers into corporate settings. “Many big oil and gas companies now have teams of emergency medical technicians and nurses who are on call in case of accidents or disasters at their refineries,” Ramirez reports. “In fact, a lot of people who have done emergency care in the past end up becoming consultants for corporations in areas like disaster management. I even see emergency nurses going into the business field—there are a lot of companies that contract emergency services to hospitals and corporations.”
Gloria Salazar, MA, BSN, RN, CEN, a 20-year veteran of the ER who is now a trauma education and injury prevention manager at Thomason Hospital in El Paso, Texas, feels that “emergency nursing is a stepping stone. Most emergency nurses have plans to continue their education or their professional development, and they eventually move on to something else.”
Think Fast
Meanwhile, back in the ED, there’s no denying that the pace is fast. Because every emergency case is different and the volume of patients is high, emergency nurses must have a finely honed ability to quickly assess what’s wrong with the patient and take immediate action. Creativity, flexibility and being able to work under pressure are absolutely essential, as are top-notch problem-solving skills, sound judgment and the ability to prioritize which patients are the sickest.
“Critical thinking skills are very important,” says Jones. “You need to be knowledgeable in managing patients with life-threatening problems. You need to be up-to-date on current trends, such as new treatments for acute coronary syndrome. You need to read articles, so that you can explore new information with your colleagues and the physicians. And when you’re carrying out an order, it’s not enough to just do it—you need to understand why you’re carrying out that procedure.”
Because everything in the ED is based on verbal orders, Kuska adds, “you have to know your medicines and know exactly what things are for, so that you can make sure the doctors’ orders are correct. You have to be able to think, ‘Wait, I shouldn’t be giving Demerol to a head-injured patient,’ or ‘The potassium he ordered is too high for a two-hour drip.’ If you haven’t acquired that knowledge from prior experience in another area of nursing, you’re not ready for the ED.”
Ramirez adds one more essential quality to the list: the ability to be nonjudgmental when faced with emergencies that could have easily been prevented if the patient had used common sense. “We recently had a case where a mother was driving with her kids in the car and her little boy was not in a seatbelt,” she says. “She got into an accident and the child flew out the window. But I can only educate her—I cannot judge her. I have to be able to stay calm and say, ‘You know, it’s really important that you seatbelt your child; he could have died today.’ You have to be an exceptional teacher.”
Cultural Detectives
Being an emergency nurse is a lot like being a detective, according to ENA immediate past President Benjamin E. Marett, MSN, RN, CEN. Often, he explains, someone will come into the ED in crisis and neither you nor the patient will have any idea what’s wrong. It’s up to the nurse to sift through all the clues—the patient’s vital signs, their medical history, what they did and ate that day, diagnostic tests such as EKG, electrolytes and cardiac monitoring, etc.—and deduce what the problem is.
“All you may know from the vital signs is that something isn’t quite right,” says Marett. “You need to have a keen ‘sixth sense.’”
Ramirez believes this “Sherlock Holmes component of emergency nursing,” as she puts it, is another crucial area in which minority nurses can make a culturally competent difference when treating patients who share their same ethnic heritage: They are more likely to be attuned to “cultural clues” that would not be apparent to someone outside of that population.
“I think that’s one of the things that gives me an edge in treating Hispanic patients of Mexican descent and some Latin patients,” she relates. “I was born and raised with these people, so it’s like an innate cultural knowledge. When they come to the ED and they’re talking a certain way, they’re using certain terms, you think: ‘Wait a minute, I know what this person is saying.’
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“Last night I had a perfect example,” Ramirez continues. “A Hispanic woman came into the ED and she was using a Spanish phrase that, literally translated, means ‘I have tonsils.’ Immediately, I knew exactly what she was talking about. She didn’t have to tell me, ‘My throat hurts and I have fever.’ In my culture, when someone says ‘I have tonsils,’ it means that they’ve had a history of tonsillary problems and now it has come back.
“All I had to do was ask her, ‘What have they treated you with before?’ She told me, ‘The shot.’ I asked, ‘The one with penicillin?’ ‘Yes, that’s the one.’ ‘Does it help?’ ‘Immediately,’ she said. ‘It’s gone within two days.’ She could have said ‘I have tonsils’ to another nurse who wasn’t familiar with Hispanic culture and they would have had no clue. But to me, it made perfect sense.”
Are You Experienced?
Even though the current shortage of emergency nursing specialists is forcing many emergency departments to hire nurses without prior ED training and experience, nurses who do possess solid emergency background and skills are in much greater demand. Moreover, because of its extremely serious and fast-paced nature, emergency nursing is definitely not a field for beginners.
“I would tell any nurse, minority or not, that before you can come to work in emergency nursing, you need a strong base in medical/surgical or another more general area of nursing,” Moses emphasizes. “If you jump right into the ER as soon as you graduate from nursing school, you’re only setting yourself up to be burnt out within a year. But if you get that base first, you’ll be able to function much better when you come to the ER.”
Let’s say you are currently a med/surg nurse who would like to make a career change to the more exciting field of emergency nursing. What specific education, experience and credentials will you need to add to your resume?
“Our hospital requires you to have taken the TNCC (Trauma Nurse Core Course), the ACLS (Advanced Cardiac Life Support) and PALS (Pediatric Advanced Life Support),” says Salazar. “There’s also a critical care course offered at our local university, and I advise the students I work with to take that. Most of the students who take those courses and then look for a job in emergency nursing are the ones that are hired right away.”
In addition, Moses advises potential ED nurses to obtain a strong grounding in technology skills by taking computer classes. “Nowadays, the whole ED is computerized,” she explains. “The patient’s x-rays, medication, everything is on the computer. For discharge planning, you press a key and you get discharge instructions; for patients’ lab work, you pull it up on the computer screen.”
One way today’s hospitals are trying to develop a larger pool of experienced emergency nurses is by increasing their investment in on-the-job training. Jones, who has earned a certificate for the ENPC (Emergency Nurses Pediatric Course) as well as the TNCC, ACLS and PALS, is a good example of a minority nurse who performs this crucial educational function within a hospital ED setting. “I precept most of the new staff that comes in, whether they are nursing students, nurse interns, ED technicians or newly hired RNs,” she says.
Jones created Howard University Hospital’s ED training and orientation program, which puts heavy emphasis on hands-on learning. In addition to classes on topics like pediatrics and critical thinking, preceptees closely shadow Jones and other ED nurses in their clinical settings. The training program also includes mock Code Yellows, mock traumas and other simulations that teach new staff members how to think and act quickly in unexpected emergency situations.
How important is the Certified Emergency Nurse credential, conferred by the Board of Certification for Emergency Nursing (BCEN)? Although the ENA endorses earning the CEN, board certification is not required to work in emergency nursing, and most of the nurses interviewed for this article agree that the CEN does not necessarily increase a nurse’s chance of being hired over a candidate without certification. Still, says Kuska, “I think that having to take the certification exam and keep up with the CEUs makes you a more well-rounded nurse. Having those letters after your name shows that you are truly committed to your specialty.”
Reaping the Rewards
Despite all the excitement, variety and respect that emergency nurses enjoy, this career is not for everybody. “You will see horrible, terrible things in the ED—gunshots, stabbings, burns, child abuse, car crash victims and more,” Marett cautions. “But it does have exceptional rewards that come when you make a real impact in saving someone’s life.”
Thelma Kuska couldn’t agree more. “It’s very rewarding, because you make decisions that really make a life-or-death difference,” she says. “If you’re an astute nurse who knows what to look for, you can really feel like, ‘Wow, I made a difference today!’
“For example, suppose a woman of child-bearing age comes in complaining of severe abdominal pain. Her blood pressure’s a little low; her pulse is a little fast. You ask when her last period was and she says, ‘Five or six weeks ago.’ So you put the pieces together and think, ‘Maybe it’s an ectopic pregnancy.’ You make the decision and tell the ER doctor, ‘I think we need an OB consult.’ There have been many times when I’ve picked up on something like that and the doctor told me, ‘Because of you, that patient went to the operating room right away. You saved a life today.’”
For More Information About Careers in Emergency Nursing
Emergency Nurses Association
915 Lee Street
Des Plaines, IL 60016-6569
Phone: (800) 900-9659
Fax: (847) 460-4001
Web site: www.ena.org
The ENA’s mission statement emphasizes that “respect for diversity of patients and colleagues is inherent to emergency nursing practice and emergency care.” According to George Velianoff, DNS, RN, CHE, the association’s deputy executive director of nursing, “We are very concerned about recruiting more nurses of color into the profession. There is a tremendous need for more minority emergency nurses.”
The ENA offers many resources for current and potential emergency nurses, including:
Access to the latest scientific research concerning emergency care
Networking opportunities with key governmental, academic and professional contacts
Educational programs, including an emergency nursing core curriculum and continuing education courses
The Journal of Emergency Nursing and other publications
An annual educational and networking meeting
Undergraduate and advanced educational scholarships
