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Career Coach

Can We Change Culture through Full Practice Authority?
November 28, 2016 10:31 AM by Renee Dahring

We have been focusing our attention on restrictive laws and practice agreements, but they are only one method the establishment uses to hold us back. Many of us who practice in states that have enacted full practice authority have come to realize that repealing outdated laws didn't solve all our issues. It's a great beginning but much more needs to be done if we want to see real progress.

During the messy business of passing full practice authority, we were acutely tuned in to what the opposition was saying about our profession. I think you are all familiar with the old, tired arguments, so I won't repeat them here. In a show of solidarity, nurse practitioners all united and spoke out loudly and shot down the barrage of misleading comments and stories about nurse practitioners. It's fairly easy to defend when the threat is blatant. But how do we fight against silence?

The culture has proven much harder to change than the laws. Despite our growing numbers and accomplishments, we are in danger of becoming the silent majority if we don't start speaking up. Let me give you an example from a national conference,  which I recently attended, of my specialty organization. This is an organization that focuses on a medical sub-specialty and this particular subspecialty is multi-disciplinary, but if you attended the presentations you would have come away with the impression that it was only physicians who were engaged in delivering direct care. Over and over I heard, "The physician in your clinic, the physician who is prescribing, the physician blah blah blah."

When I thought about it more, I also began to notice that when I attend many provider workgroups that include NPs as equal members the default is still "the physician." And if it isn't "physician," it's that good old generic "advanced practice clinicians/providers." While that term is lightyears ahead of "mid-level," it still does not acknowledge us as a separate and distinct profession. Now, I love my PA colleagues, but the truth is that both our professions ought to insist we be called by our proper names. I am an NP, the care I provide falls into the nursing model. A physician assistant does many of the same things I do but they don't practice nursing. I have to think that my PA friends also get a little tired of the assumption that they are no different from NPs and would like the PA profession to be appreciated and applauded for it's unique history. Lumping us into what amounts to an "other" category does nothing to advance (no pun intended) either of our professions.

Well, I have finally had it, and I decided I need to speak up. In my conference evaluation, I will be noting my disappointment in the exclusionary language my particular organization continues to use, and I encourage you to do the same. As NPs and PAs we provide important contributions and make up larger and larger numbers in various organizations (and we pay dues to those organizations!). It's time to speak up and stop the marginalization of our roles. If we stay silent we will continue to be an "invisible" class of providers.

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Filling in Résumé 'Gaps'
November 7, 2016 8:31 AM by Renee Dahring

Dear Career Coach: I am an NP, but I have not worked in 2 years. How can I get back into the workforce?

Dear Reader: You are not alone! Your question is one that I am asked with some regularity. I have a number of thoughts and a few points to share that you may not have considered.

Usually when NPs who have been out of the workplace reach out to me, they are primarily focused on the present; they want to know how they can get back into the nurse practitioner working world. They will typically ask me what sort of job would best suit them or how to convince an employer to give them a chance. They worry that an employer is going to assume their knowledge and skills are rusty. However, you might be surprised to learn that prospective employers are more interested in the past. Before you can talk about your future, you will have to supply an explanation about why you left practice in the first place.

There are as many reasons that an NP might leave the workforce as there are NPs. While some reasons are more understandable than others, it's necessary that ALL gaps in employment that last longer than a month be fully explained. When reviewing your work history, one of the first things a recruiter or hiring manager will do is look for employment gaps. If your application is submitted online and electronically processed, the employer will have set the software to scan and eliminate candidates who have employment dates that are not continuous. Any application that fails to address the reason you stepped away from you last job for an extended period of time will raise a BIG RED FLAG.

Right about now you are probably feeling like you are experiencing a bit of a catch 22. You are challenged with accurately noting your work experience on a résumé while also having to note doing "nothing." You might be wondering exactly how it is possible to put a job you didn't have on your résumé.

Well, the first answer is that you weren't doing "nothing" during your time away. Chances are you have a good explanation, even if you don't think you do. You haven't said why you were not working as an NP, but I am sure if I asked you, you could tell me.

So what I would like you to do is create a new "job" entry under your work experience section on your résumé. You will title this entry with a brief but informative title that explains your absence without going into the TMI (too much information) realm. For example, you can state "maternity leave," "care for aging parent," "spouse relocated," or "personal leave." You will also provide "to and from" dates for this entry just as you did for your paid job entries. This satisfies both the computer and the human reviewer that you aren't trying to sneak something past them. You have acknowledged your time away while sparing them a long story. Longer explanations are reserved for interviews, not résumés.

Too reassure the employer you haven't become rusty, create a section called "continuing education" and outline the steps you have taken to remain current. You can also write a nice cover letter to expand further on how you have maintained your skills. If you haven't done any conferences or workshops then you need to attend a few before you start submitting applications.

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Enjoying Your NP School Years
October 24, 2016 8:39 AM by Renee Dahring
NP students frequently ask me if there is anything they can do before graduation to help prepare for their first job. I assume they are looking for the usual "job-search advice," because they seem somewhat surprised when I tell them what they are doing now—in schoolis the best preparation.

I don't actively encourage students to start job searching while still in school, because school is hard and it's busy, and once you are done, you are done. No one returns (voluntarily) to repeat their NP program a second time. Studying and clinicals deserve your full attention. Being a student is like having a passport to observe and experience an incredible amount of medical conditions and situations without having full responsibility yet. Once you are done and working, you won't have the luxury of just being there to learn. You are missing out if you don't take full advantage of your student status. Absorb everything you possibly can; use the "I am a student, can I watch/listen/tag-along" line every chance you get before you graduate. Trust me. Once you start your first job, you are going to miss it.

I advise students to do their best in prioritizing school over their RN job. Unfortunately, I see too often that school gets slotted around in between work schedules. Yes, I understand that with the high cost of tuition and general living expenses most students have to work, but school is an investment and you need to nurture that investment or it won't grow. Your current job is about to become your past; your new role is your future. You will be an NP for the rest of your career and a hospital nurse only until you can work as a nurse practitioner.

So where does it make most sense to focus your efforts? Do you want to continue to invest in something you will be leaving soon or does it make more sense to put your energy into where you wish to be for the next few decades? Again, you won't be an NP student but once. Think about it.

The last piece of advice I give students is to find their passion. Job hunting before you have given some really serious thought to the type of position you want is not a recipe for happiness. It's tempting to jump at the first offer you receive, especially when you are a student and struggling financially. Any job with a regular paycheck can look appealing. This is why so many new grads are out looking for a new job in less than a year after they start their first job.

Slow down, be the best student you can, and do some soul searching. Your future NP self will thank you.

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The Power of the Résumé
October 10, 2016 9:49 AM by Renee Dahring
A potential employer is the only audience your résumé needs to impress. Not your instructors, not your colleagues, and not your mother. If your résumé doesn't pass this test, it has not been written properly, and improperly written résumés don't get interviews. No interview = no job.

Poorly written résumés generally share a few key characteristics that cause the applicant to be passed over. These are common mistakes that both NP and PA job seekers makeand make quite frequentlywhen crafting their résumés.

Let's first review the purpose of a résumé.

The function of a résumé is to market yourself and to demonstrate to a potential employer that you have enough of what they are looking for in a clinician so they want to meet you in person and learn more. That's right. Your résumé serves one purpose and that is to get you an interview. If you have the notion that your résumé will get you the job, you are missing the point. No one has ever been hired directly from a résumé.

Résumés are also reviewed in 30 seconds or less. This means you better get to the point quickly. You can't afford to drown the employer in a mountain of irrelevant details that have nothing to do with the job qualifications. One of the biggest résumé sins you can commit is including too much info about skills or experiences that will be of no use to the employer, because they do not correlate directly to the open position. For example, an ortho practice really doesn't care that you can do pap smears or have expertise in well-child exams. Nor do they care what you did prior to becoming an NP or PA. How exactly will your work as a barista or bank teller possibly make you more marketable as an NP or PA?

The answer is that it won't. Including all your unrelated experience is not only going to confuse the employer as to what makes you think you are qualified, but it also makes you look unprofessional and distracts from your pertinent skills. Worse yet, you look as if you never read the job ad. And that is not an impression you want to make.

Try to put yourself inside the head of a hiring manager trying to meet the needs of their clinic, and then ask yourself what in your background will best demonstrate you can do the job. Keep that in mind, and you are far more likely to construct your résumé properly, thus becoming more likely to be asked to interview.

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The Evolution of the Job Search
September 26, 2016 8:58 AM by Renee Dahring
Job searching has evolved. Where we go to find a new job is not the same as it was even a year ago. It's tough to keep up with the trends. If you haven't changed jobs for several years, you're going to find out that the strategy you used to find your last job is no longer effective. If you are a new grad who is beginning the search for your first job, chances are the well-meaning advice you get from your instructors is outdated.

So what has changed?

Some of you may remember the big "job boards" that were popular a few years ago. There were basically two kinds of boards. Specialty or "niche" boards existed primarily to host job ads for either NPs or PAs or both. Employers paid to post their positions, and job seekers could either regularly visit the board or post a résumé and wait for calls. The other type of board that was popular was what I call the "big box" board. These boards were not specific to our profession but were so big and had such high-name recognition, they had the capability of reaching more job seekers, because they showed up at the top of most search engine results. What both types of job boards had in common was that the job seeker actively had to seek them out. In other words, if you weren't out looking for work you would never see the ads.

Now, most job ads come to you. One of the ways this happens is that the ads are placed on websites you're visiting for other reasons. You may have noticed that many of your professional organizations are hosting job ads. Makes sense right? Now when you visit your favorite healthcare information site, you are likely to see ads targeted to you and your interests. Much like your favorite online retail stores, technology has evolved to have a pretty good idea of what type of job might catch your eye based on your browsing history and previous searches.

Direct email is another way to promote job openings. Again, the jobs are quite specific and may come from either an employer or as a mass emailing from an organization or staffing agency. I get several of these each week.

If you are opting out of these emails, you are making a big mistake. Just because you aren't looking for work today doesn't mean the emails and ads aren't helpful. For one thing, they keep you up to date on market trends and salaries. You can use this information to renegotiate your current position, which is helpful. And if you do decide to seek a new job, your search will be more effective, and in general you will be better informed as you start your job search.
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The Importance of Joining Organizations
September 12, 2016 9:36 AM by Renee Dahring
Labor Day seems like an appropriate time to take stock of the current state of where we are as a profession. During the last few years, we have made great strides. Nurse practitioners have full practice authority in almost half the states in the US. Not too shabby. A lot of hard work has gone into bringing us this farhard work on all levels. I say this all the time: If you don't belong, you should. There is strength in numbers. The national organizations guide us and provide support; they bring attention to our achievements on a macro level. Join one or join many. It's all good.

And don't forget about your state organizations. State and local organizations do the heavy lifting of organizing and lobbying. Bills need grassroots support at the legislature to pass, and this is where state organizations shine. If you want to put your dues to work close to home on issues that affect your practice, then you have to begin at the state level. Yes, even if your state has full practice authority, there is still work to be done. Don't let your membership expire just because you don't have any of the big "flashy" issues on the table. Monitoring for new bills that threaten NP autonomy requires constant vigilance. You should never underestimate the chance that new bills will be introduced specifying that only physicians may perform a specific service in a sly attempt as an ends to run around NP full practice authority. There are also countless existing statutes that do not include NPs, which need to be amended.

Yes. There is much work to do at the state level. Join one or join many.

Changing the culture is a tougher issue. In my home state of Minnesota, we have almost 2 years of full practice authority under our belt, yet we hear many organizations have been slow to adapt to the new law. A survey conducted about 9 months after passage of full practice authority revealed that almost all NPs were still being asked to sign a collaborative agreement despite the fact it is no longer required by law. Many employers also will not accept an NP signature on certain formsor perhaps I should say they CHOOSE not to accept an NP signature. These are concerns we can't legislate. An employer can always be more restrictive than the law. Changing attitudes is going to take some time and some organization.

Your local organization can help to set a tone of full practice authority acceptance. An organization can educate an employer in ways that an individual cannot. An organization of many individuals has much more leverage than a single person.

Join one organization or join many. On a local level, the yearly dues for most organizations cost less than a dinner at a nice restaurant. Nationally, it's the equivalent of a really nice dinner. We make decent money. Celebrate Labor Day by joining. If you are already a member, renew and/or join a second or third organization.
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How to Find the Right Job for You
August 22, 2016 8:37 AM by Renee Dahring
No one wants their dream job to turn into a nightmare. My recruiting days were spent listening to NPs who were frustrated and wanted out of their current position. Salary and benefits weren't the problem; the problem was literally the workplace itself. They told me stories of toxic workplace cultures, horrendous work expectations and miserable co-workers. Finding yourself in a dysfunctional workplace is the last thing anyone wants. Sometimes it's impossible to see it coming, but more often than not in retrospect the NP would admit to me they missed a few clues that all was not well.

I've compiled a few of these clues to help you avoid ending up in a problematic workplace:

Buyer beware: When it sounds too good to be true... If potential employers makes promises to you during the hiring process that make you want to pinch yourself to make sure you aren't dreaming, then you probably should pinch yourself. I always get a little worried when every inquiry or request-a-job-seeker makes is answered by "yes." No one gets everything they want. The more likely scenario is that the employer is only telling you what you want to hear. It's not necessarily bad that an employer wishes to please you, but when it leads to multiple broken promises then it does become bad. The employer may mean well, but no one likes empty promises.

Excessively high pay. This too should sound an alarm. If an employer has to offer over-market salaries it could be a sign of deeper problems. File this under "too good to not have strings attached."

Circumstantial evidence. I always advocate asking about the circumstances that lead to the job opening. As a recruiter finding out why the previous employee left the position was one of my standard questions. Sometimes there is a good explanation. I know of one workplace that had a large number of clinicians who all hit retirement age during one particular year. That makes sense. Sometimes a spouse moves or an illness leads to a resignation. If the explanation is a little fuzzy, then your antennae should go up.

High turnover. You have to wonder why some organizations seem to be looking for new NPs, or for that matter, any employees on a continuous basis. We all know of workplaces that are perpetually hiring. Unless they have built a new wing or started a new program, that ought to be a big red flag. Oh, and high turnover at the management level isn't a very reassuring sign either.

Hiring you too quickly. I get a bit uncomfortable when an employer is ready to hire before doing their due diligence. If they can't take the time to have you do some paperwork or check references, that smells of desperation.

Pay attention to the chatter. Do your homework if things don't seem quite right to you. With social media, it is easier than ever to do detective work. Look at organizational reviews online, check out their Twitter or Facebook feeds. It's hard to hide dysfunction.
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Re-evaluating the ‘Dream Job’
August 8, 2016 8:55 AM by Renee Dahring
What's the first thing that comes in to your mind when I say the words "dream job?" I would venture to say your initial thoughts will go in the direction of pay, hours or perhaps location. If I gave you a few minutes more to ponder, you would likely add some other elements such as the patient population you will be serving, the number of patients you have to see per day and perhaps no call duties.

Now this is where it gets interesting. You may be surprised to learn many NPs who contact me looking for a different position tell me they currently have all or most of that list. If you are an NP who is not happy with your current job, you aren't likely to cite any of the above as reasons for your displeasure and desire for a new job. Instead, you will assure me you actually are making very good money and the hours might not be great, but you don't mind. Your benefits package is generous; in fact, that is part of the reason you have stayed as long as you have in this position. And yes, you really do love your patients. What you will tell me is that you no longer have a job that you can look forward to going to every day.

So what then is the problem? Pay, benefits, great patients-what more could you want?

Well, let's start with a happy work environment. Unhappy clinicians tell me they want to find a workplace that has both a great boss and co-workers. They want respect, good communication and to be valued for their contributions. They don't want to be miserable every day, dealing with unreasonable bosses, gossiping co-workers and increasing paperwork demands.

For unhappy clinicians the characteristics that define a dream job have undergone a major revision. Pay and benefits aren't at the top of the wish list anymore and have been replaced by requirements that really can't be written into an employment contract. What they want now are the intangibles.

My advice if you are in this situation and seeking a new job is that you take your time and pay attention to your intuition. I guarantee there were probably some warning signs that you either missed or even ignored.

As a former recruiter, I learned a few tricks to spotting a troubled workplace.

Stay tuned, I will share them with you in my next blog.

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Ups and Downs of an Online Program
July 26, 2016 8:10 AM by Renee Dahring

A large and reputable healthcare organization in our community has recently added a footnote to all posted NP job openings, declaring they will no longer hire new grads from "certain programs." The excluded programs are not named, but you will find a very short statement that refers to "proprietary online" schools this employer feels do not meet the standards of their healthcare organization. 

I can't say I am really surprised. There were signs-a couple of years ago, many local healthcare organizations began refusing to precept students from any program that did not have a bricks-and-mortar school within our state. They claimed it was a liability issue. I don't know if that is true or not, but I do know it left a great many students scrambling to find a clinical site. 

On the NP side, I am hearing from a number of NPs who have graduated and now feel that they were not adequately prepared. These NPs tell me they are having a hard time either keeping a job or finding a job. Many, to their credit, recognize the need for remediation and are searching for positions that will provide them with some on-the-job mentoring. 

Complicating the poor preparation is the fact that all too many of these NPs lacked RN experience. They either went directly or worked only a year or two before going on to an NP program.  

Now, before you send me hate mail, I know there are many good NPs from online programs and from what we call "direct-entry" programs. And yes, I know that many of these programs are extremely rigorous and produce some very fine graduates. But we need to be honest and admit there is also a growing number of programs that are iffy and a growing number of student NPs that are not prepared for practice. 

This is a problem folks. 

It's a fact of life that bad experiences are talked about much more than good. People are quick to talk about the programs that fall short or the new grad that is struggling. Planes that land safely or rush hours without car crashes don't make the evening news. 

Our image is at stake here. Once a perception is established, it can be hard to correct. This can have dire consequences for us when we are working so hard to achieve full practice authority.

I don't have any answers, do you?
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You Know the Dos; Here are the Don'ts
July 11, 2016 2:20 PM by Renee Dahring
There are some things you just shouldn't do during your interview. Negotiating is at the top of the list. If there is anything that will make you radioactive, it would be trying to pre-negotiate the duties or terms of the open position. Some career advisors will tell you if you can't find a position you like or that suits your interests, then you should apply for an opening that is somewhat like the job you want and, once you have the employer's attention, you can pitch your idea of how you would like them to accommodate you and your dreams. Uh-huh. That might work in another field, but it goes over like a lead balloon in our profession. I am going to tell you why you should never, ever take this approach.

Your first impression is deception. So you didn't actually want the job but applied anyway hoping to persuade them you had a better idea? Applying for a position under false pretenses is hardly the way to endear any employer to you. Bait and switch comes to mind. You have taken up an employer's valuable time and energy to deliver your own personal sales pitch for a product they didn't ask for or want-what could go wrong? Only your job prospects. 

Too much too soon. Negotiating before a job offer is made is seen as arrogant and assuming. I mean, you don't even know for sure if they want to hire you and there you go trying to get a better deal. Don't put the cart before the horse. You wouldn't ask someone to pick out wedding invitations on your first date would you? You might be surprised at how often I heard this complaint from employers. It would seem that a great many candidates will attempt to negotiate wages, hours and a whole host of other subjects during the first interview. Bad manners and a bad idea.  

Your best bet in the interview is to let the interviewer do what they brought you there to do, which is to interview you! Remember, employers are hiring to meet their need. If you have been invited to interview, it's because they have determined that you possess the skills they are seeking and now would like to get an idea of who you are as a person. Employers want to hire clinicians that will fit in with the clinic culture. If you are trying to work a deal or haggle over terms and benefits during that first meeting, you pretty much ruin your chances of the employer learning anything but the wrong things about you. 

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It's OK for New NPs to Need Guidance!
June 15, 2016 12:27 PM by Renee Dahring

Dear Career Coach: I need some coaching to help me find the right NP job. I graduated with my MSN in 2012 and am currently working, but I am having difficulty due to not getting what I needed in my graduate program. I am also a certified diabetes educator and would ideally like to combine my extensive experience in diabetes education with an NP role. I need a lot of guidance and clinical support in the NP role because I just don't feel I can be completely independent at this point.

When applying and in an interview setting, how do I present myself as confident and competent while also asking for guidance and support?

Dear Job Seeker: The most helpful advice I can give you is to recognize that what you are experiencing is completely normal. It's unrealistic to expect someone to graduate from an NP program and be fully independent. You are a beginner, and that is OK. Yes, even someone practicing for 2 to 3 years can be a beginner if they haven't had the right guidance. This can be difficult for new and newish NPs to accept, especially after years of practicing as an RN. It's hard to go from being the expert back to being a novice. Give yourself a pat on the back for admitting your limitations.

It's also not necessary for you to be completely independent or proficient in order to appear confident. In fact, if you are honest in your representation of your skills and abilities, you will make a far better impression on your interviewer. However, that doesn't mean you are going to focus on the negative either. How you frame your experience (or lack of) is really what makes all the difference in how you will be perceived.

Start by pointing out your strengths and stating what you do well. When describing your skills, avoid making equivocal statements that start with "I think" or "I might," which tend to make you sound less confident. Affirming statements such as "I can" or "I am" will make you FEEL more confident too.

When you are asked about areas in which you have less expertise, always start your response on a positive note and never repeat a negative. For example: "I have taken care of many patients with asthma but I would appreciate additional learning opportunities to refine my prescribing skills." Not "I am not very familiar with asthma medications but I think I just need more practice."

Applying for jobs that don't suit you and your skill set may increase your anxiety and cause you to appear less confident. Look carefully at the job description to evaluate if the position is a good match for you.

Be upfront in your interview that you are seeking a position that values and supports collaboration. Ask about the orientation period and who will be available to you for consultation. Looks for practices that have previously hired new grad NPs and avoid settings where you might be scheduled alone. Be honest in your desire for a mentor. If an employer is put off by your honesty or can't provide a workplace environment that meets your needs for further learning, that is a strong indicator it wasn't the right position for you.

 

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Thinking Bigger
June 1, 2016 8:21 AM by Renee Dahring

As I follow legislative and policy issues I see a theme. I call it the "I'll have what they are having!" approach. In addition to working toward full practice authority, we put a great deal of effort into making sure that existing policy law is inclusive of advanced practice providers. We are making strides at the federal level toward securing the ability to order things like home health. Makes total sense. You would be hard pressed to find an NP who is philosophically or ethically opposed to ordering shoes for patients with diabetes.

At the state level, we are on alert to watch for new bills that exclude us-whether it is on purpose or from habit. We as a profession have made progress, but the tradition of referring to medical providers as "physician" is not easily changed. Much of the time it can be chalked up to habit, much like we call all tissues "Kleenex" even when we buy the store brands. Sometimes it's actively meant to exclude other providers. This is where a good lobbyist is essential. In addition to catching exclusionary language, lobbyists serve as a constant reminder that we are watching and will not stand by and let ourselves be marginalized. This is how we change the culture.

My concern this past year is that we haven't yet moved past the "me too" phase. A number of issues are on the horizon that should prompt us to consider our position. While we are working on changing the term "physician" to "provider," we should take care not to overlook the big picture. It's not enough to be included; we must start asking ourselves where we stand on the topic ... not just the language.

A number of highly controversial subjects have emerged in healthcare, and we need to weigh in on them as a group. For instance, where do we stand on medical cannabis? What is our position on assisted suicide? Various physician groups have published their stances on these two hot button issues, but we have been mostly silent.

The reason I bring this up is that while we may feel our autonomy is protected by adding our names to legislation, doing so may be shortsighted if we don't first develop a stance. These are subjects that folks are passionate about, some of which may be faith based. It may not seem like a big deal now, but I worry that it could be a very short walk from our professions being eligible to participate in these activities to finding ourselves being compelled to participate. It's time to start thinking bigger.

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Job Market Update
May 18, 2016 9:04 AM by Renee Dahring

We are halfway through 2016 and I figured you might be ready for a little market update. Let's look at a few trends.

Market Strength

Generally speaking, the job outlook remains quite strong. There are plenty of job openings and most folks seeking a job will likely land a position in a reasonable amount of time. However, even in a strong market you shouldn't get the idea that jobs are super easy to find. You will find some spots, particularly in the Midwest, where the market is saturated. Other areas, such as the eastern seaboard, have more than their fair share of open positions so practitioners looking in those areas will find job searching relatively painless. 

As always, the danger in a strong market is overconfidence. My contacts in the recruiting world assure me than even with a surplus of jobs there are still plenty of applicants for each open position. There is also some general concern that we might be approaching a tipping point where the supply of new practitioners becomes greater than the pipeline of new jobs. It is probable that the burst of new NP jobs that were added after the affordable care act was implemented will begin to level off soon as we reach maximum capacity.  Bottom line - you still need to bring your A-game when applying for jobs!

Market Demand

Primary care demand remains strong and that is not likely to change. Those who possess family practice credentials remain the most employable. That's not to say there are no specialty jobs, it's just that even in a specialty practices we have seen a preference towards seeking practitioners holding a family certification. The exception is psych-mental health. If you are a psych certified NP, CNS or PA you hold the golden ticket. The increased demand for mental health services coupled with a psychiatrist shortage has created a boom market for our mental health colleagues.

Market Employment Trends

The temporary-or locum tenens-market remains strong. Even when your ultimate goal is a permanent job, if you are willing to consider a short term position you can greatly multiply your job prospects. This may not make sense, but the truth is that many temporary positions turn in to offers for permanent positions. Hiring is big commitment and employers want to get it right. Bringing someone on board initially under a short term contract allows the organization the ability to determine whether the clinician is a good fit for the position. And by the way, this should be important to the job seeker as well. It's a lot less messy to part ways after a 2-3 month contract and if it doesn't work out both parties get to leave with their dignity intact.  

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Are NPs & PAs Facing Burnout?
April 27, 2016 3:34 PM by Renee Dahring
I have been hearing the "B" word in relation to advanced practice more frequently lately and it's beginning to worry me. Not because burnout is new, it isn't, we have been talking about burnout for years, but usually in the context of how we can fill the void of physicians deciding to leave practice. In fact, if we are completely honest, physician burnout has probably indirectly been a benefit to our profession. Remember, we market ourselves as one of the solutions to the growing physician shortage.

Now we are beginning to hear the rumblings of nurse practitioner burnout. In my home state of Minnesota a bill was introduced this legislative session to fund a study of NP burnout. Observers are asking, "Is there a problem?  Are NPs leaving practice due to burnout?" The nurse practitioner who initiated the bill says we simply don't know, and according to her that is precisely the problem. Her contention is that physician burnout has been studied extensively while little attention has been paid to NP burnout. And apparently PAs must be feeling the same concerns about burnout because it didn't take long for them to successfully lobby to have PAs included in the bill.

The talk about burnout was inevitable. When we emerged as a practice we had a number of strong selling points.

We can manage most of the same conditions as physicians, but we don't cost as much! We will spend more time with our patients! Hire us; we will help grow your practice!  

And that has begun to happen. For the last couple years NPs and PAs have been named as one of the fastest growing jobs. Twenty-one states have full practice authority for NPs. We are no longer in the shadows; we have our own practices and our own patients.

There is a line from a 1968 movie in which a character warns a rising pop star band "The tragedy of *your* time, my young friends, is that you may get exactly what you want." The implication is that sometimes the very thing you work so hard to achieve can have unintended consequences. Of course in the movie, the group soon implodes because they failed to plan for the downside of their enormous success. 

Like the group in the movie, we focused on the benefits of being treated more like our physician colleagues and didn't consider how we might handle dealing with the same stressors that are driving MDs from practice. Turns out we aren't immune from the frustration of shorter appointment times, too many patients, overbearing insurance companies and employers who care only about patient satisfaction surveys. Pretty much everything that physicians experience, only we do it for less money. 

Yep, that's pretty much the recipe for burnout.

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Lunch Interview Etiquette
April 13, 2016 8:15 AM by Renee Dahring
Dear Career Coach: I am a new graduate and recently had a preliminary screening interview for an NP position. I met with one of the providers and the interview generally went well, I liked them and they liked me. After the first interview I compiled a list of about 15-20 additional questions I would like to ask about the position. Now I have received an invitation to have a lunch meeting with a few of the other providers in the practice. I would like to bring a print out of these questions to the lunch meeting. My dad disagrees with me, he has advised me that I should "listen more and talk less." Who is right? How will I get my questions answered?

Dear Out to Lunch Job Seeker: First let me congratulate you on your job search progress! An invitation to a lunch meeting is a good sign that you made a good impression during your first interview. Lunch interviews can be a new experience for both new grads and seasoned clinicians so you aren't alone in wondering about the proper etiquette.

Lunch meetings are more informal and unstructured; the intent of the meeting is more about getting to know you than to assess your clinical skills or negotiate the terms of a pending offer.  A lunch meeting is an opportunity to introduce you to your future colleagues and get a sense of how you might mesh with the team. As I have written in many other columns, employers are looking for more than just someone who can do the technical aspects of the job, they want someone who is a good fit. It's very important to the employer that they hire someone who will fit well with the culture of the workplace. In other words, they want to get to know you as a person and get a feel for what your personality is like. Unconsciously they will all be asking themselves "would I want to share an office with this person?" 

Certainly you will be asked some questions, but it is just as likely that at a table of several people you might not actually be doing the bulk of the talking. It's expected that you will ask questions, but bringing a list might be a bit off putting in the setting of a more social meeting.  You also should limit your questions to inquiries about office routines or practice philosophies.  Topics such as salary, benefits or vacation time can ruin the mood and are best saved for a later date. You can always follow up with HR or the person who originally interviewed you after the lunch meeting.

However, if some of your 15-20 questions happen to come up naturally in the conversation at lunch, then by all means ask away! 

I advise you take your father's advice. Sit back, relax and enjoy the lunch.

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    Occupation: Nurse Practitioners and NP Recruiters
    Setting: correctional healthcare/career consulting/teaching
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