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Career Coach

Dear "Supervising/Collaborating" Physician
September 3, 2014 1:07 PM by Renee Dahring

Dear "Supervising/Collaborating" Physician,

Our relationship has to change. 

It's not you, it's me. I have changed. I have grown and matured. I am not the same nurse practitioner I was when we first met. I have been around awhile now; I am no longer a new profession that is trying to find my role in the healthcare world. I have been working hard, and over the last few decades I have gained experience and confidence. I feel I have proven myself, and now I have the studies to prove that I consistently provide quality patient care that has equal or better outcomes. You seem surprised - you say that you don't understand why I feel need to move on. I recognize that you are hurt because you thought our relationship was fine and that we seemed to be getting along so well. I suppose this is part of the problem, you haven't really been paying attention. The truth is this relationship has been working better for you than it has for me.

I need some space. I'm not okay with these "agreements" you have been forcing me to sign. Yes, I know you feel somewhat protective when it comes to the practice of medicine, but the bottom line is that you are a physician and I am a nurse practitioner. As time goes on, I have begun to realize that it just doesn't seem right that one profession can determine the fate of another. You and I are different. You need to accept that just because we do some of the same things does not mean you have the right to be in control of my practice. Perhaps you aren't aware of this, but many of your colleagues have been charging us an obscene amount of money for these "supervisory" agreements. Why should we pay a lot of money for a signature on a piece of paper that doesn't result in any benefit to our patients or improve healthcare? In fact, all this paperwork has actually decreased access to care by adding unnecessary restrictions on my practice and adding more cost to an already overburdened healthcare system.

We can still be friends. I value the relationship we have had over the years and hope I can still count on you to be there when I need you. But for our friendship to move forward, you are going to have to trust me. You will have to trust that I was educated to know my limits and that I know when it is time to refer my patients. The only thing that is changing is that we will no longer need such a formal agreement. You see, I have also noticed you don't treat other professionals the same way you treat me. I find it hard to believe that we need to have a written agreement with each other when I see you freely collaborating with your colleagues. Just because I want to end the "supervision" part of our relationship doesn't mean I don't respect your knowledge. We will still work together, but now it will be as peers that both bring valuable contributions to patient care. 

Sincerely,

The Nurse Practitioner

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Precept to Perm
August 20, 2014 2:05 PM by Renee Dahring

I'm seeing a new trend taking hold - it's called "precept to perm." It is hardly a new idea, but it has been given an official name, causing it to trend and become more common. If you are a student, you might have already encountered this phenomenon. If you are a seasoned clinician looking for a new position, it could impact your job search, as well. 

"Precept to perm" refers to the practice of a healthcare organization agreeing to precept a student with the understanding (or stipulation) that the student will then work for the organization upon graduation. In theory, it's a win-win situation. Students benefit by having a guaranteed preceptor, and in return employers have a supply of future clinicians that don't require the energy and expense of recruitment.

We used to see this arrangement play out quite often in the specialties, but in a much less formal way. The difference was that the student wasn't expected to commit to future employment prior to beginning the rotation. Employers tended to be selective and would precept only those students with strong interests in that specialty. Specialties have always liked to train clinicians themselves, and many prefer the "blank slate" of a student or new graduate so that they can train the clinicians to do things the way the practice prefers. This worked quite well because the student didn't have to make a commitment before they were ready and it also kept the employer motivated to provide make a good impression on the student. This mutual tension insured that everyone played nice.

Some are still playing nice. For many students, the precept to perm arrangement will work out just fine. Many students come to love their clinical rotations and like the security of knowing they will have a job waiting for them after graduating. 

But there is also a downside. There will always be some students who don't fit into this model, and as a consequence, they will have trouble finding a clinical site. For example, students who will be relocating after graduation can be shut out of rotations simply because they will be seeking employment elsewhere. There are many students who still aren't really sure what sort of job they want, even up until the day of graduation. Many tell me they feel pressured to "sign-on" before they have made up their minds or risk being passed over. 

Asking students to make commitments to a job that is still 1-2 years away creates stress and takes away from their educational experience. A student's first priority should be their studies while they are in school.

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Employers & References
August 6, 2014 1:24 PM by Renee Dahring

References can make or break a job offer so it is important you understand how to choose the right references. 

  • You need to be sure that the persons you name as your references have DIRECT knowledge of your work performance. Choosing folks that think highly of you is not enough if they have never actually worked closely with you. This is because the questions that your reference will be asked will pertain to your work habits and skills. In fact, most reference forms consist of a list of specific procedures or competencies and ask that your reference rate your proficiency for each of them. Obviously, your neighbor, minister or best friend won't be of much help in evaluating your work skills.
  • Keep it current. In addition to having firsthand knowledge of your skills the employer will also expect your references to have RECENT knowledge. The expectations are that your identified references have known you at least a year and have worked with you within the last year. If you dredge up folks from previous positions or that have only known you a few months you will be raising some major red flags.
  • If you are a PA or an NP in a state with a collaborative agreement, the expectation is that you use your collaborating or supervising physician as a reference. Employers really wonder what is wrong if the person you have a legal agreement with in order to practice will not serve as your reference. This is not just a red flag - it's a red flag on fire. In my experience, this can be a deal breaker. If you have a valid reason, such as you are afraid you will get fired if they know you are job hunting then you need to be upfront with your prospective employer. Since employers shouldn't be contacting your references until the offer has been extended to you then I suggest that you can get a commitment from them to move up your start date if contacting your collaborating MD creates any negative consequences for you.
  • If you are a new grad, it is critical you have at least one reference from your program. If none of your professors are willing to act as a reference, then employers are going to see that as a problem.
  • And as a reminder, the general rule of thumb is three references (ideally one supervisor and two peers). It's great that the support staff loves you but that's not likely going to impress a potential employer.
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Job Interviews & Food Allergies
July 16, 2014 11:01 AM by Renee Dahring

Dear Career Coach:  I am a new grad NP with celiac disease and I am unable to eat at restaurants due to potential cross-contamination that inevitably leaves me ill for a week. What suggestions do you have to handle not being able to eat at a restaurant, without coming across like a "major diva" as you mentioned?

Dear Reader:  The structured office interview is how the employer learns more about your skill set and experience, but in order to gain a greater understanding about who you are and how your personality might fit into their workplace culture many employers like to connect in a less formal and lower key environment such as lunch or dinner. So because this is such an important part of the interview process we need to find you a solution.

I feel it is important that you not decline the invitation so I will give you a few ideas that you may find helpful.

  • 1. Just say it. The bad news is that food allergies, intolerances and sensitivities have become more common. The good news is that food allergies, intolerances and sensitivities have become more common. It's likely that everyone who will be attending knows someone or has treated someone who has a dietary restriction for a medical reason. It's also likely that they will understand the importance of your request. Also in your favor is that you will probably be working with either H.R. or an office assistant to set up the meeting so you may feel you can speak a little more freely. Remember too that your medical history is technically protected information and H.R. should not be sharing what you tell them with your future boss and co-workers.
  • 2. Don't overshare. Spare the details and the history of your issue. Going into what has happened or may happen when you eat a particular food WILL make you sound like a diva. I would simply keep it simple and just say "I have a food allergy" and then share the specific accommodations you will need.
  • 3. Offer a solution. If you know of a particular restaurant that you trust to prepare your meal correctly then by all means offer to meet there as an alternative. If you absolutely can't eat food prepared in a restaurant then perhaps you could suggest meeting for coffee. If you meet mid-morning or afternoon in a coffee shop then the expectation to order food will be less and you won't feel so uncomfortable.
  • 4. Call ahead. Most of the better restaurants should be able to meet your needs if given some notice. Talk to the manager and explain the situation and come up with a plan. Tell them that it is imperative that you a safe meal without calling unwanted attention to your condition.
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Job Hunt Pointers
July 2, 2014 8:26 AM by Renee Dahring

If you are about to look for your first job or you are just thinking about making a change, I have a couple pointers for you:

  1. Job searching requires a plan. Before you send out your first resume or application, you should have an idea of what it is you really want in a job. Sit down and make a list of YOUR job requirements. If there is one thing that employers dislike it is non-serious candidates. Finding a job shouldn't be a fishing expedition. Applying for jobs that you are only lukewarm about can come back to haunt you. Employers pick up pretty quickly on applicants that are out there just testing the waters. As I have mentioned in other blog posts, responding to every job you see posted can backfire, and can very likely cause your name to be flagged in the system for multiple applications- that is not a good thing. You may think that applying for every opening makes you look interested and eager but employers disagree. What you are saying to a potential employer is either a) you are desperate or b) you have no idea what you want to do.
  2. If you are a seasoned clinician considering a new job, prior to sending out your first resume you should have already determined exactly what it will take for you to leave your current employer. Determine your bottom line in terms of salary, benefits and hours. If it is clear that the new employer will not be willing to meet your requirements then don't apply for the position. I am aware that many job ads do not state the compensation package up front. When that is the case, you are going to have to do some homework. Better to spend some time on the phone tracking down the recruiter or hiring manger than to submit an application to a job that doesn't offer what you decided you will need.
  3. Once you have determined your bottom line, stick to it. If you tell a prospective employer that you need A, B and C during an interview and then when an offer is on the table you inform them that now you need D, E and F there is going to be a problem. No one likes a bait and switch. And believe it or not, employers don't like negotiations any better than you do. If you make your expectations clear from the beginning the employer knows what they have to do to close the deal. The only caveat I have is that you should be reasonable. Outrageous demands make you look unstable and out of touch.
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NPs: Continue to Educate and Demand Respect
June 18, 2014 9:35 AM by Renee Dahring
A funny thing happened on the way to full practice authority...

We have been working hard for years on passage of a bill to update the nurse practice act and free APRNs of outdated and restrictive practice agreements. In fact we have been focused for so long on achieving our goal that we haven't really thought much past - well, achieving our goal. We put a great deal of effort into winning hearts and minds and last month our hard work paid off: the governor signed the APRN bill and our dreams of full practice authority were realized. On January 1st, 2015 the new law will go into effect and mission accomplished, right?

Not so quick. Our arguments may have won over the legislators and a good portion of the public, but we are learning that it may be a bit premature to declare victory. Our opponents didn't get what they wanted at the Capitol, but that doesn't mean it's over for them.

It seemed so promising when we reached an agreement, but perhaps it was only the battlefield that changed and not the battle. While we were pursuing our goal on the house and senate floors, organized medicine had already turned their attention to the workplace.

I don't think it's a coincidence that many large healthcare organizations have been quietly altering the job descriptions for their NPs. Practices are being restructured so that NPs no longer have their own patient panel and are now required to "share" a panel of patients with an MD. Recent job ads describe the NP as working under the "supervision" of an MD. It's looking suspiciously like what the docs were unable to put into statute they are now putting into work rules.

And yes, they can do it. It's perfectly legal for an employer to be MORE restrictive than the law.

But we don't have to like it. And we don't have to work for them. We must continue to educate and demand respect. If you are one of the folks out looking for a position, you need to let employers know that these terms are not acceptable to you. I know it's a little scary when you really need a job but if we allow our roles to be diminished now it will set a precedent. It's much harder to undo rules than to make them.

This is where I make a plea again for you to get involved with your local and national professional organizations. We cannot let this become the accepted culture. Remember, the price of freedom is eternal vigilance.

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Working on Your Resume? Remember the ‘Big 3'
May 21, 2014 8:11 AM by Renee Dahring

Dear Career Coach: I think I need a professional to write my resume. I have a resume right now that is 8 pages long and so boring it puts me to sleep. I'm sure there is a ton of overkill in it but I'm a nurse practitioner, not a resume writer. I'm not sure what to keep and what to get rid of. My resume goes all the way back to my first nursing job. I just can't seem to let it go for some reason. Maybe it needs to go or maybe it needs to stay ... I just don't know. I would greatly appreciate any recommendations from you.

Dear Reader: It seems that the hardest thing for nurses to do is edit themselves! It may make you feel better to hear that most NPs have a tendency to put too much info into their resumes.

When trying to decide what information to include and what to remove, try repeating this phrase to yourself: The purpose of this resume is just to get me an interview. No one has ever been hired based solely on their resume. This will help put you in the proper frame of mind to begin the process of letting go.

Employers want only one thing, and that is to put the right candidate in the right job. Your resume should demonstrate to the employer that your qualifications are a potential match for the position. Too much other information just muddies the waters and won't increase your chances of landing an interview.

To boil it down to the basics means that the reviewer will be focusing on what I call the "Big 3."

1. Do you meet the educational requirement?

2. Do you possess the correct license and certification?

3. Does your experience and skillset match the job description?

What stays and what goes? Look at each entry on your resume and ask yourself if it is pertinent to the job you are seeking. Prune out information that is not applicable. If an item isn't pertinent to the job you are applying for, then it probably isn't worth keeping on your resume and you can safely let it go. How do you know when you have it right? If a reader can look at your resume and know exactly what sort of job it is that you seek, you have written an effective resume.

Don't get too carried away. You don't want any gaps in your employment, so if a previous position is not relevant do NOT omit it, just make the entry brief. No need to elaborate on skills and duties that have nothing to do with the job you are seeking.

The rule of thumb for how far back to go on your work history is 10 years. Seasoned NPs need only include their NP experience, so that should help you cut down the size considerably.

And lastly, I don't recommend hiring someone to write your resume. The reason for that is twofold. First, you need to tailor you resume to the position. A resume writer will produce a generic one-size-fits-all version and you won't be much better off than you are now. Second, employers often complain that candidates don't seem to know their own resumes. I suspect this is because they hired someone to write their resume for them.

 

 

 

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This Nurses Week, Examine Your Message
May 7, 2014 2:16 PM by Renee Dahring
For as long as I can remember, nursing has been one of the most trusted professions. We should be very proud of that status -- it's not easy to gain the trust of the public, much less mange to hold on to that trust year after year.

We have never campaigned or actively sought out this designation, instead we earned it by simply doing our jobs day in and day out. Nurses don't really like to show off or brag, we prefer to just let our work speak for itself.

But now our role is changing and we need to start thinking more seriously about our "marketing." We may be trusted, but we need more. We need authority.

Let's start with who we are. Even though many legislators have heard of nurse practitioners, few have a real understanding of our role. If you don't believe me, try lobbying your state legislator! You will find that before you can even begin to plead your case for independent practice, you will have to explain what exactly you do and what "advanced practice" means. I am convinced I can see eyes glaze over when we say things like "scope of practice," "nurse practice act" and "consensus model." And just try to explain all our different certifications. I dare you!

We desperately need professional help to bring some clarity to our messaging. In the business world there is a saying that "if you don't manage your message, someone else will manage it for you." That means you need to speak up or you run the risk of having others define you. It's no accident that we have terms like "midlevel" and "nonphysician provider." Who do you think chose those demeaning labels? And who continues to use them? Don't kid yourself, organized medicine knows the power of those words.

And speaking of organized medicine, those folks take their own messaging seriously. There is no doubt in my mind that every word they say has been crafted and focus grouped to have maximal impact. I watched over and over legislators nod and agree when meeting with NPs, only to have seeds of doubt sown later by physicians. If an MD says something, it must be true, right? The public professes their love for nurses but when push comes to shove they still take what physicians say more seriously. Why? Because doctors have done a good job putting forth messaging that establishes them as "authorities." Marcus Welby may have gone off the air more than 40 years ago, but somehow organized medicine has managed to keep the myth alive that everyone in healthcare works for the physicians.

We can change this paradigm. But we can't do this on a one-to-one basis. It will take an organized effort. If you are member of a nursing organization, urge them to consider a PR campaign. Get involved. Speak up. That's the proper way to celebrate Nurses Week!

 

 

 

 

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Let's Do Lunch
April 23, 2014 8:26 AM by Renee Dahring

Today I am going to discuss an interview type that can make many job seekers a little uncomfortable: the lunch or dinner invitation.

You have applied for a job, and the practice has invited you to a restaurant. The invite might occur early in the process or it could be the last hurdle before the official offer. It might be fine dining or the local café. Make no mistake, no matter what it is called or where you go, it is still an interview so the standard rules will still apply. Dress professionally, show up on time and be prepared to ask and answer questions. But, as they say, the devil is in the details.

Here are a few etiquette pointers to help you lower your stress level.

  • 1. Order something easy to eat. Please stay away from any sort of finger food. Virtually no one is going to look dignified eating with his or her hands. Seriously, have you ever watched someone trying to eat a large burger? Not a pretty sight. Any food that you have to touch will also lead to food getting on your hands. This leads nicely into tip #2.
  • 2. No messy or drippy food. Stay away from spaghetti or foods that have a juicy filling. I don't know about you but the nicer I am dressed, the greater the chance that I will spill. I mean, isn't it a known fact that "dry-clean only" clothing attracts spills? Note, ribs and burgers violate both #1 and #2.
  • 3. If you are picky eater or have a lot of "special requests," keep them to yourself. You are going to sound like a major diva if you have a laundry list of do's and don'ts for your food. Asking for your dressing on the side can be forgiven but if you are getting into fat, salt or garnish discussions, you have gone too far. No one wants to hear that. Your goal is to be remembered for what you said during the interview rather than for how much you stressed out the server when you ordered.
  • 4. No alcohol. I don't care if everyone else at the table is having a glass of wine YOU are not to partake. The other people at the table can drink - they are not the ones interviewing for a job! In order to be on your best behavior, you should stick to nonalcoholic beverages.

I do, however, recommend treating yourself do the adult beverage of your choice when you get home. :-) 

 

 

 

1 comments »     
The Way Healthcare Used to Be
April 2, 2014 5:01 PM by Renee Dahring
I find myself thinking quite a bit about how much healthcare has changed since I was young and trying to figure out how it is that we have come to find ourselves in our current situation.

I just want to state, for the record, that I am not that old. I was a kid in the 60s and I had my children during the 70s and early 80s. I am not talking ancient history here, only the last 50 years. 

When I was growing up my family didn't have health insurance. My father, who was a hairdresser, was considered self-employed so he did not receive any work benefits. But what he did for a living probably wouldn't have made much difference, because during that time most families didn't have health insurance as we know it today. With the exception of a major medical policy that covered only hospitalizations, people expected to pay for all clinic visits and medications out of their own pockets. And we did. And somehow it was affordable. Even the occasional trip to the emergency room wasn't unmanageable for most budgets. And for that matter, neither was having a baby. I had no insurance when I had my children but it didn't send me to bankruptcy court. Granted, my youngest was 5 years old before I owned him free and clear, but the monthly payments were reasonable! 

But that was another difference: We actually saw our bills. It's only in the last 30 years or so that bills starting going directly to the insurers rather than the patient. In those days it was up to the patient to submit the medical bill to their insurance company and wait for reimbursement.

There were no big healthcare "systems"; clinics were mostly privately owned. I also remember visit times being longer and less rushed even though charts were on paper and few offices even owned a fax machine. A person could get an appointment in a reasonable amount of time and if not perhaps a phone call was sufficient because the clinic "knew" you.  There was no such thing as an urgent care and believe it or not the emergency rooms were not overflowing. 

What is going on? I know the "good old days" weren't always so good but is this really progress? Yes, there have been some great advances in healthcare but are we really getting that much more for our money? It doesn't seem that patients are that much healthier (or happier) and not a day goes by that we don't hear grumbling from providers who are forced to dance to the tune of insurers and regulators. 

Maybe I am getting old ...

 

 

 

 

 

 

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New Grad Resume Style
March 19, 2014 2:47 PM by Renee Dahring
I was speaking to a group of spring graduates a couple weeks ago about how to create an effective resume. In my talks I emphasize the importance of both content and format. Those of you who are familiar with my website and my various articles will note that when it comes to resumes, I recommend a pretty standard format. 

After I finished my presentation, a soon to be new graduate raised her hand to voice a concern. "I am worried that my resume will look pretty much like everyone else's resume if I follow your advice."  

My answer? Yes, it absolutely will! That is the goal. 

Recruiters and human resources personnel review a lot of resumes and they review them very quickly. In fact, most resumes will get no more than a 30 second look - if even that much. Your goal is to make it as easy as possible for the reader to determine whether or not you meet the qualifications. In other words, you don't want to make your reviewer work too hard or have to dig too deep to find the pertinent information. The best and most reliable way to accomplish this task is to use a standard format. 

Think about it. That's why we use a standard format, such as SOAP, in the clinical setting when we chart. Because the format never varies, the reader knows exactly how and where to find whatever piece of information they require. Easy peasy. Key information is located exactly where we expect it to be. 

I think the student's real concern, and what she was actually getting at, was a worry that maybe her unique personality wouldn't shine through. Well, remember, the only purpose of a resume is to get you an interview. That means at this stage of the application process it's far more beneficial for you as a job seeker to showcase your skills rather than your personality. Style doesn't belong in a resume. After all, it's a resume, not Facebook. 

I feel the need again to remind all job seekers to always keep in mind that when it comes to landing a job it is all about what the employer wants - and what the employer wants from your resume is simply to determine whether or not you meet the qualifications. 

But don't employers also care deeply about whether or not your personality and style are good fit for the culture of their organization? Yes and the proper place to demonstrate that will be during your interview, not in your resume. 

2 comments »     
The Providers of ‘No'
March 6, 2014 8:36 AM by Renee Dahring
Ready for my rant?

Over the past year or two, I've noticed an increase in physician groups engaging in negative campaigning directed toward NPs. Could it have always been present but I just hadn't noticed? Or is the negativity a reaction to the numerous bills that have been introduced in several states to remove barriers and allow fully independent NP practice? The conspiracy theorist in me suspects the latter.

Whatever the reason, I am now aware. I have also detected some common themes that have emerged often enough that I have to believe they have to be carefully crafted "talking points."

They go something like this:

The horror story. A case that is so uncommon and rare will be presented to illustrate that even the most common of illnesses can't possibly be managed without the skill of an MD. "I just saw a patient in clinic last week who had an earache and it actually turned out to be an ancient medieval disease that hasn't been seen in a century! Thank goodness I saw them and not the NP!" The purpose of this is to scare the consumer into believing they are only one step away from a medical disaster at any given time and only a physician can save them.

Go team go! After decades, MDs have apparently just discovered the "team." Of course, by team they don't mean themselves, they just mean YOU. NPs need to be in teams that are led by physicians. "We cannot have patient-centered care unless physicians are part of the team!" Forgive me if I am a tad cynical when I hear this claim. I mean, what's been stopping them? They have essentially been running the healthcare show for years and until now haven't been very interested in true team care.

Do no harm. Organized medicine has cleverly repurposed this classic phrase and is now using it to defend the status quo. "Gosh, we wouldn't want to make any changes until we can be SURE that this will solve all our healthcare access problems and not fragment care any further." We are meant to believe that fragmentation of care really only occurs when patients are seen by NPs. Fragmentation is perfectly acceptable when docs own the urgent care clinics (and hire NPs and PAs to staff them).

Is it just me or are the organized medicine groups starting to sound like the "providers of no"?

"No problems with the current system"

"No need to change"

"No solutions"

It's a shame a few vocal physicians are sending such a negative message.

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Selling Your Salary
February 19, 2014 4:40 PM by Renee Dahring
I usually conduct a brief survey when I speak to groups about job searching. I ask participants to rank a list of topics to indicate where they feel they need the most assistance. The choices are: resumes, cover letters, finding job openings, negotiating and interviewing. Across the board the recipients choose negotiating to discuss. This holds true whether I query new grads or seasoned clinicians.  

The results are not so surprising when you consider that the market has been improving for both our professions. A few years ago it was a challenge to find a job, much less get an actual job offer. Now that jobs are relatively easy to land, we now have the luxury of focusing more on our compensation. 

"Nobody likes to talk about money, but everyone wants to be paid," a former colleague of mine used to say. As a profession the idea of negotiating tends to make us a bit squeamish. Publicly we are seen as healers, and the implication is that we shouldn't really be talking about money. However, privately we are like everyone else who has a mortgage and bills to pay. 

Our backgrounds and education don't do much to prepare us for negotiation either. If you listen to the so-called "experts" you will be lead to believe all negotiations are a contentious back and forth horse-trading type affair. You know, an endless cycle of smoky backroom deals where they make an offer, you counter offer, then they counter your counter, and continue ad nauseum. No wonder most of us suffer from "negotia-phobia"! 

Out of curiosity I attended a breakout session on negotiating at a national conference. The level of anxiety in the room was palpable as participants we treated to a summary of "tactics." It was there that I had an epiphany. This wasn't a talk on conducting negotiations, it was a lecture on how to make demands! 

I realized that an essential key concept was missing.

Before you can negotiate, you must first make the sale. It's only after making the sale that you can begin to have a conversation of the terms of the deal. 

So if you want to have a less stressful negotiation, then study sales. You will learn a sale does not start with a price. It starts with both parties coming to an agreement on the need for the product. Think about the last time you made a large purchase. There were likely many features and benefits you didn't even know you needed until the sales person pointed them out. By then, you were happy to pay the asking price.     

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How to Incorporate Student Experience
February 5, 2014 5:50 PM by Renee Dahring
Dear Career Coach:

I am an experienced PA and was reading your resume tips for NPs. However, I'm wondering about your guidance on listing clinical rotations. You mentioned listing clinical rotations is only a good idea if you are a new grad NP. Do you think the same applies for PAs who have completed rotations in surgery and other procedural specialties? (ER, general, surgical, derm/plastics, etc.)

Dear Reader:

To answer this question you should ask yourself:

  1. Will it confuse the reader as to my status? i.e., new grad vs. experienced
  2. Is the experience pertinent? 
  3. Does it make me more competitive?

Generally, whether you are an NP or PA, if you have obtained your first position it's time to retire the student rotations section from your resume. One of the reasons is to eliminate confusion for the prospective employer. It is one way of saying "I am no longer a new graduate - I am a practicing clinician with actual work experience." 

If you are a new graduate, your student rotation section is the most effective method to demonstrate to the employer that you possess the pertinent skills. What you did as a student is really the only valid experience you have in the advanced practice role. And because the job opening is for an advanced practice clinician (not an RN or EMT) this section becomes crucial. 

Many new grads mistakenly believe their RN or other healthcare experience is going to be more valuable than it really is and they will devote too much space on their resume to their previous non NP/PA jobs.

It's OK to briefly include your previous healthcare positions on your resume but you are far better off putting more emphasis on outlining your student clinical rotations. Why? Because your RN or EMT skills aren't going to give you much of an advantage if your competition is experienced NPs and PAs. And quite frankly, if an employer wishes to know more about your jobs prior to school they will ask you in the interview. 

In your example of seeking specialty practice, I believe that your student rotation experience is pertinent and would make you more competitive. Since specialty rotations can vary from student to student the prospective employer would have no idea that you had spent time in the related rotation. Speaking of pertinent, I would only include the rotation(s) that applies to the job you are seeking or you risk violating the above criteria. 

To avoid confusion of your status, I would note your student experience in a separate section from your work experience and clearly label the section "related experience." Keep it brief, include information such as the number of hours, the types of cases and identify your responsibilities and accomplishments.

Your cover letter is also another avenue for you to expand on the past experiences you had as a student.

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Interviewing Attitude
January 15, 2014 2:54 PM by Renee Dahring
During the course of interviewing for a new job you are sure to be asked for the reason you are leaving your current job. How you answer this question is important. Let me guide you through a little exercise to assist you in formulating your response. 

First, I would like you to make a list all the reasons you want to leave your current position. Maybe it's the work atmosphere or maybe your have a boss who is a micromanager. Or perhaps the nurses are hard to get along with and making your workday miserable. Politics - there are always office politics.

It could be your work schedule you dislike, such as the hours or days you are working. And then there are the patients - too few or too demanding - it's usually one or the other. Or pay, could be that you feel that you are not being paid what you are worth and you don't see a raise anywhere in your future. 

Great, now that you have the negatives out of your system please tear up that list and never speak of it again. 

Instead, I want you to replace the list with all the reasons you want a new position. And this list is going to focus on all the positives of a job change. In this list you will reframe being "sick of your current dysfunctional co-workers" to "seeking new people and new challenges." You desire "opportunities for growth" and you have "achieved the maximum potential growth at your current job."

Of course you will remark on how much you have learned, and how you will use that knowledge in your next position. Your dissatisfaction with your pay should be put on the backburner until you are actually negotiating an offer and not brought up as a reason for leaving your current job. I am presuming that you did enough homework prior to the interview to be assured that the pay range for the new job meets your expectations. If you don't already know the pay they are offering then shame on you!

My point with all this is that you need to project a positive attitude during your interview. Find a way to put a positive spin on your experiences. Nobody wants to hire someone who is a complainer or who is negative. Employers put a great deal of weight and importance on behavior. How you act during an interview is a proxy of how you might act with your colleagues, and more importantly, how you might act with a patient. 

Oh, and if you have been taking your work complaints to your social media page you might want to do some turbo deleting. 

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    Occupation: Nurse Practitioners and NP Recruiters
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