Looking Out for Our New Nurse Grads: The Future Prospects for New Grads (2786 hits)
Laura A. Stokowski, RN, MS
Be a Nurse...If You Can A popular Website about the nursing profession claims, "there has never been a better time to be a nurse." "Be" a nurse? Perhaps, but "become" a nurse? Perhaps, that is less certain. In spite of continuing to rank among the best careers and best jobs in America, the nursing profession is struggling to welcome its newest members with open arms and paychecks.
Experience and Employment: The Vicious Cycle Now, the bloom, as they say, is off the rose. It seems that many of our new grads are stuck in that perennial dilemma: They can't get a job without experience, and they can't get experience without a job. This situation was not anticipated by thousands of nursing students who were told, often repeatedly, that a global nursing shortage practically guaranteed employment for them.
New grads get conflicting messages about RN employment after graduation. The messages that nurses are getting these days are not only confusing, they are downright conflicting. The Bureau of Labor and big government think tanks tell us that the role of the nurse will be more important than ever before in the changing healthcare system. Here are the latest projections for employment outlook for nurses, from the US Bureau of Labor: "Overall job opportunities for registered nurses (RNs) are expected to be excellent, but may vary by employment and geographic setting. Some employers report difficulty in attracting and retaining an adequate number of RNs. Employment of RNs is expected to grow much faster than the average and, because the occupation is very large, 581,500 new jobs will result, among the largest number of new jobs for any occupation. Additionally, hundreds of thousands of job openings will result from the need to replace experienced nurses who leave the occupation."
Advice for New Graduate Nurses Chris Jackson, Director of Recruiting for a large, mid-Atlantic hospital is still taking resumes from new graduate nurses to fill full-time, internships, externships, and part-time openings when the needs exist. "About 25% of our resumes are from new grads," explained Jackson. I asked Mr. Jackson what was the most important attribute in the current tight job market. "Flexibility," responded Jackson. "The applicant who is flexible on working hours, shifts, and unit will have an advantage." Jackson also places a premium on a combination of the right technical skills, compassion, and commitment.
The National League for Nursing and the National Student Nurse Association have published a brochure titled, "Your First Position in Nursing. Realities of the Current Job Market," which is full of helpful information. Here are a few tips for the new graduate who is looking for a job: ~Plan ahead. Don't wait until you graduate or take boards to take action toward finding a job. Working as a certified nursing assistant (CNA) while you are in school can give you valuable experience and expose you to people who might be valuable to you later on when you are searching for a job, especially if you make a favorable impression. While still in school, look for internships and externships that may lead to future employment. If you do get a position as a CNA, intern, or extern, try to find a mentor and cultivate that relationship.
Before you graduate, take advantage of any services offered by your school's career center. Take the NCLEX as soon as you can. You won't be considered without passing it. Get your resume in order and don't neglect to portray your specific skillset. Make sure your resume is tailored to the job you are seeking.
~Hunt efficiently. New positions are usually posted first on hospital or agency Websites. Don't neglect newspapers and nursing publications. Attend job fairs in your area, and expand your area to include cities and counties further afield. The job situation can be very different across state lines and in rural vs urban areas.
~Align your expectations with reality. Depending on where you live, you might have to consider jobs other than your preferred "dream job" in the hospital. Don't discount positions in primary care, ambulatory care, rehabilitation, or home health. Look at the Veteran's Administration facilities in your area.
~Be flexible about location and shifts -- and don't ask "how long will it be before I get on days?" Jackson has observed that, as a consequence of the economic downturn, fewer new graduates come into interviews these days with completely unrealistic expectations about the type of position they can get.
~Get some experience. Jackson emphasizes the urgency of getting some type of nursing experience -- as much as you can -- whether it is an internship, externship, outpatient setting, or even volunteer nursing work. Many students fear that having short-term employment in a clinic or long-term care facility on their resume will harm their chances of being hired. However, Jackson explains that this is not always true. In evaluating the applicant's employment history, he explores the reason for the short-term employment and makes judgments on a case-by-case basis.
~Continue your education. If you have an associate's degree, consider going on to get your bachelor's degree now, rather than later. Many hospitals have the luxury right now of hiring only nurses with bachelor's degrees. Consider pursuing advanced education to prepare you to work in areas of emerging or growing demand such as geriatrics, chronic disease, genetics, and informatics.
~Network. Join your school's alumni association, state nurses' association, or a national nursing association's local chapter. Attend meetings and meet people who might have tips on where the jobs are in your area. If you know nurses who are employed, keep in touch with them so that they will let you know of job openings.
~Interviewing. You've heard it all before -- get your resume in shape, dress professionally, be prepared, and arrive on time. However, in a tight job market, the importance of the little things is magnified even more. You will be asked all the usual questions -- your career goals, why you became a nurse, your strengths, your weaknesses, your flexibility, -- and the classic, "Where do you see yourself in 5 years?" In addition to those questions, be prepared to express your awareness of and commitment to the issues that really drive the entire healthcare institution: quality, safety, teamwork, evidence-based practice, civility, professional ethics, and customer relations. An understanding of the issues critical to an organization's success will set you apart from others who may be applying for the same job.
The Future Prospects for New Grads Nursing employment patterns have always been relatively elastic, expanding and contracting as nurses increase or decrease their working hours according to their financial need. As the economy improves, nurses who have put off retirement or avoided reducing their work hours are expected to return to their original plans. This should open up opportunities for new graduates. It's hard to tell if it's fact or wishful thinking, but many experts are saying that the job prospects for new graduates are going to improve in the near future. This prediction seems to hinge on the economy, at least in the short term. Large numbers of baby boomer nurses may have put off retirement temporarily, but this situation can't last forever. Eventually, these nurses will retire, easing the job crunch for newly licensed nurses.
Transition-to-Practice Programs One solution is to boost the number of internships as community-based transition-to-practice programs for new graduates. The National Council of State Boards of Nursing has launched a multistate (Illinois, Ohio, and North Carolina) study to evaluate safety and quality outcomes of nurse transition to practice programs. Newly licensed nurses hired to work in hospital settings will be followed during their first year of employment, during which they will participate in interactive, online transition to practice modules, work one-on-one with a preceptor, and receive institutional support from the hospital. Patient outcomes will be included in the analysis. The program includes training for preceptors. Data collection is scheduled to begin in July 2011.
Transition-to-practice programs aren't designed to repeat what is learned during the basic nursing education. Instead, these programs aim to help newly licensed nurses acquire skills that are essential to nursing but are difficult to acquire as a student nurse: providing care for a full patient load, supervising care provided by others, delegating, time management and prioritization, interaction with physicians, decision-making, synthesizing data from multiple sources, and appropriately applying research findings to practice.
New Entry to Practice Settings In an era when much healthcare is shifting into ambulatory settings, and only the sickest patients remain in the hospital, it is no longer feasible to require or even encourage new graduates to work "a year or two" on a medical-surgical unit before branching out into areas such as home health, intensive care, or mental health. Researchers have begun to look at programs for integrating new graduate nurses into healthcare settings that have not traditionally been seen as entry into practice settings. Meadows described a pilot project that successfully integrated new graduate nurses into home healthcare, skipping over the usual prerequisite for a year's acute care experience.
Proulx and Bourcier redesigned an orientation program specifically to accommodate new graduate nurses who enter practice in critical care. Some hospitals have even opened up internships in areas that have previously been considered too challenging for new graduates, such as psychiatry and the operating room.
Keeping the Momentum The inability to find jobs after graduation has been a rude awakening for the newest members of our profession. Still, it is imperative that we find ways to continue the pipeline of new nurses. The shortage of nurses may have been stalled temporarily, but it could reach crisis mode again if the anticipated mass exodus of older nurses comes to fruition in an improved economy. Innovative programs such as transition-to-practice and orienting new graduates to nontraditional entry to practice positions offer some hope for integrating new graduates into the workforce even when jobs are scarce, but these efforts are not sufficiently widespread to get all of our new grads doing what they hoped to do after graduation: working!
