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Career Coach

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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Interview Preparation
March 30, 2016 7:35 AM by Renee Dahring
I am often asked for pre-interview advice, especially by new graduates. It's natural to worry about interviews, but new grads feel extra anxious.  They want to impress, but feel a little like they won't measure up because they have no work experience yet. 

Let me try to help alleviate some anxiety with this quick inside advice about interviews. 

First of all, the interview is as much about the employer promoting their position and their workplace as it is about you. It's not at all uncommon after an interview for a candidate to feel like the prospective employer did all the talking! That's OK, even if you didn't talk much you learned some valuable information. Jobs are like marriages, in that it goes both ways and will only work if both partners have some affection for each other. If interviews focused entirely on you it would be difficult for you to make a decision. 

Employers are looking to meet their own needs. Yes, they want you to enjoy and grow professionally, but the overall driving force is to find a clinician who has the skills they seek. Remember this when you answer questions or are asked to talk share information about yourself. It's great that someday you want to run a bed and breakfast, but that is not really going to impress a prospective employer. Give some thought about what skills you possess that will be of benefit to the organization. Hint: they told you what is important to them in the job ad. Make sure your answers assure them that you fit the bill.

Stay positive. This might sound like a non-brainer, but many candidates don't realize when they have strayed into negative territory. Don't talk about what you can't do, talk about what you can. Emphasize all that is right about you. Too many new grads let insecurity talk over and focus too much on what they are lacking. Remember, your clinical rotations are your skills. Before you interview go back and review your clinical logs to refresh your memory about the types of experiences you gained during school.  Resist the urge to yammer on about your previous jobs duties - including RN - you want to be seen as looking forward rather than living in the past. If they want to know more about your work life before your NP or PA program let them ask you. 

Be prepared for the strength/weakness question. This is an interview staple so there is no excuse for having no answer! Most interviewees do OK with the strength question, but find it harder to articulate a weakness so instead try the old trick of turning a weakness into a strength. "I work too hard", "I take on too much." Bad idea; a better strategy is to choose a clinical skill that could use some improvement and then follow up with a plan on how you intend to bring that skill up to speed. 

Integrate these tips into your preparation for your interview and stop worrying!

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Taking the Job: Yes or No?
March 16, 2016 8:18 AM by Renee Dahring

The answer is "a definite maybe." 

I was approached after a resume writing talk I gave by a soon-to-be graduate. Seems he had a dilemma.  He told me he had applied for a job and was fairly certain he would be offered the position.  Right about now you are probably wondering "how is this a dilemma?" Many new grads would love to be in his shoes 3 months before graduation.  A job offer is a good thing and the answer to accept should be easy, but there are times when the offer only brings more confusion and it can seem as if there is no good resolution. 

I asked the new grad why he was conflicted. The young man proceeded to tell me that he was reluctant to accept because it was the only job he had pursued thus far and he felt it was too soon to be making a decision. He wanted to know how he could ask them to wait until he had a chance to check out some other jobs. He felt he had no basis of comparison at this early stage and worried there might be better opportunities out there after graduation.

In other words, the job offer is not the problem here. Delaying a response to the employer is also not the problem here.  Employers understand that job seekers have been actively applying because they are in the process of interviewing for more than one position. Under these circumstances an employer will accommodate waiting for a response. Up to a point. Asking for 1 week, occasionally up to 2 weeks, to decide on whether to accept will be OK with most employers. Of course, that is assuming the candidate has responded promptly to the offer and communicated a request for more time. What is not OK is NOT acknowledging the offer and not responding for 1-2 weeks. What is also not OK is asking for several weeks because you just are at the beginning of your search and want to shop around some more. 

As I said, employers understand multiple interviews, but they don't understand lukewarm enthusiasm.  Applying and interviewing for a position before you prepared to make up your mind about that position comes across not only as a lack of preparation, but a lack of passion. It's understandable that as a student approaches graduation they are eager to get out there and start working in their new role. On the other hand, the downside of applying too soon is having nothing with which to compare the job.  The only option for this student to get out of this situation with his dignity intact now is to decline the offer. Asking for a couple month extension is not going to reflect well on this gentleman. I told him you must give them an answer, but there is no need to share his inner dilemma - just thank them for their time and gracefully decline. Better to protect your professional reputation. It's always possible that the position or another one like it with the same organization will become available once the job seeker feels he is really ready to make a decision. 

Never burn a bridge you might one day need to cross again. 

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5 Tips for Cover Letters
February 24, 2016 8:43 AM by Renee Dahring

Dear NP Career Coach: I am having difficulty with my cover letter. I am an NP who graduated in 2007 and became ANCC certified in 2013. As a nurse I have worked in many care environments and I have also held several leadership jobs such as nurse manager and clinical leader. I am determined now to transition into NP practice. I have recently taken a NP Practice Update and Pharm update. How do I find the balance between having no NP experience and presenting my nursing experience as valuable?

Dear Job Seeker: This is a more common situation than you might realize. It's true that if a year or more has passed that it become more difficult to find that first NP position. But the good news is that it is not impossible, you just need to have a good strategy. 

Here are five tips that will help you if you have a large span of time between graduation and your first job.    

  1. Own it! You are correct in identifying that you will need to explain in your cover letter why you have the long gap since graduation. Ignoring the obvious isn't a successful strategy. The key is to put a positive spin on your decision while avoiding the need to over explain and sound like you are making an excuse. Let the reader know this was a purposeful decision to continue to work as an RN because you had an opportunity to gain some important leadership experience. Point out that the skills you have gained will enhance your performance as a NP.
  2. Why now? Your cover letter needs to show the reader that you have passion, not just passion in general, but passion for this particular job. Yes, this means that each job is going to need an individualized cover letter. One size fits all cover letters stand out like a sore thumb and do nothing to convince the employer that you are serious about their position. This is true in general, but becomes even more important when you are in the position of having to prove yourself.
  3. Highlight your refresher courses. After you have explained your absence and proclaimed your enthusiasm you must address the employers concern that your skills have become rusty or outdated. Whenever there is a gap of greater than a year it's critical that you demonstrate to the employer that you have taken steps to stay current. Refresher courses show you acknowledge your challenges and that you are motivated to be fully prepared for your first job.
  4. Don't try to be something you aren't - which is seasoned. Regardless of how long it's been since you graduated you are still considered a new graduate. While you aren't saying this in your cover letter do keep it in mind when you are applying for jobs. Choose only jobs that are new grad friendly. It is okay, however, to point out how your leadership makes you a better new grad candidate.
  5. And lastly, you may want to consider working with a recruiter. Because recruiters work directly with the employer it's a little like having a back stage pass. A recruiter has direct access to the ear of the hiring manager. Sometimes it's just better to explain certain situations verbally and a recruiter can do that for you.

A cover letter is essential for all applications, but critical when you have a story to tell or situation like a gap between graduation and your first NP job that you need to explain. If properly written, a cover letter can open doors and help you take that first step to your first job.

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Locum Tenens Rates
February 10, 2016 2:47 PM by Renee Dahring
Dear NP Career Coach:  I am considering doing a locum tenens assignment. I have over 2 years of experience as a NP in urgent care where I treat some very high acuity patients. I am wondering what you think is a reasonable hourly rate? Can I also ask for all expenses such as travel, rental car, food, etc. to be paid? What about CME?

Dear Job Seeker:  Your hourly wage will really depend on the job you will be doing rather than the job you are leaving. Actually, now that I think about it that is true for all jobs whether they are temporary or permanent. However, you past experience is worth something and there may be some wiggle room to negotiate based on the skills you bring to the table.

When doing locums, you generally will get a really good wage OR you will get a generous stipend (we call them per diems) for expenses. In other words, the more you ask for one the less you get of the other. The reason for this is that employers have a defined pot of money set aside for each position and in the end it's all about how you wish to divide it up. 

Travel to and from the assignment and lodging are fairly standard to be covered and often the employer will arrange and pay for these expenses directly. Some travelers will ask for the lodging money as a per diem and then find their own lodging. Sometimes this works out well if they can find less expensive lodging.  

Per diems can also include meals, mileage or certain other types of expenses. The reason some travelers take more as per diem is that per diem money is not taxed so in some circumstances it effectively increases your compensation. However, when I say it isn't taxed that is true only up to a point. For instance, you can't say "I would like to be paid $10/hour and receive all the rest as a per diem" in order to avoid paying taxes. The IRS has is one step ahead of you and has established maximum per diem rates based on geographical area. And the geographical area is where you will be working and not where you are permanently living. So the bottom line is that you can ask for more on a per diem, but everything over the IRS rate will be taxed. You may need to speak with an accountant to determine what method will serve you best. 

Your malpractice should be covered by the agency. CME and PTO can be offered, but are not always standard in locums.

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Identifying Your References
January 27, 2016 9:25 AM by Renee Dahring
Are you graduating this spring? Now is the time to identify your references. Before you begin your search for your first job, fill out an application or send out your first resume you should know by now who you plan to use as your references. Actually, let me go a step further, you should also have confirmed with them whether or not they are willing to be a reference for you. 

New grads often put off creating a reference list until the last minute because they are not sure who to choose as a reference. I'm going to relieve some of your anxiety with these basic guidelines for choosing your references.

First, you should know that the standard number of references is three. 

Employers want references who can speak directly to your skills. Many reference forms will contain lists of specific skills and will ask your reference to rate you on your performance of those skills. In order to do that the person acting as your reference will need to have some direct knowledge of your performance. The person in the best position to evaluate your new skill set is a preceptor. Your preceptors have been working side by side with you and can attest to your strengths as well as your areas that need further development. Another option is an instructor who does your clinical site visits and has observed you during some clinical encounters.

Employers prefer that references have a similar background and education as the applicant. This means for a new grad the best references come from instructors and/or preceptors. These are the groups of individuals that have the best understanding of what your future job will demand and can best speak to whether or not you are suitable for that position. References from current or former co-workers such as RNs, social workers, etc. are not especially helpful. Supervisors are okay, but their knowledge is limited to how well you performed in your previous role and not your new role. References from non-medical persons should absolutely be avoided. 

Employers expect to see at least one person from your NP or PA program among your references. It is a major red flag if a new graduate cannot find anyone from their educational program who is willing to serve as a reference. Now is the time to approach your professors. As discussed above, choose one that has some relevancy to the job you seek and some knowledge of your skills. Don't seek a reference from the professor who taught an online lecture only class.

For practical purposes all of the references you choose should be folks that you think will respond in a timely manner. The disorganized and the procrastinator may be nice people, but they are the wrong people to rely on as a reference. In the lead up to an offer an employer may request references from two to three candidates in order to make the final selection. It's unrealistic to expect the employer to wait around too long for responses from your references. Choosing the preceptor or instructor who has piles of unfinished paperwork accumulating on their desk doesn't bode well for a prompt response.  

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Interview Follow-up
January 13, 2016 8:39 AM by Renee Dahring
Dear NP Career Coach:  I usually send a thank you letter after an interview on the same professional ivory resume paper and envelope as I use for my cover letter and CV. Is this acceptable? Or should I send an actual thank you note card? Recently I interviewed for a job and sent a thank you letter less than 48 hours after the interview. Is it okay for me to send a follow up email? And if so, what is appropriate to say?

Dear Job Seeker:  First of all, let me applaud you for your attention to common courtesy! In our busy and informal world too many applicants overlook this step which is too bad because a last impression can count almost as much as a first impression. Remember, people may not always remember what you said, but they will always remember how you made them feel. In my experience fewer than 20% will follow up with a formal "thank you". In addition, thank you notes are not just good manners; a note also serves as a nice gateway to opening further communication with your prospective employer.

In the past we tended to be more formal and recommended sending a thank you note card via snail mail. Times have changed; it's now perfectly acceptable to send a follow up email expressing your thanks. There is nothing wrong with your choice to send a thank you letter on paper (although if you are still sending out paper resumes we need to talk!). I guess what I am saying is really no wrong way to be polite.

What should you say in a thank you note? For the most part you want to keep it simple. Thank your interviewer(s) for their time and the opportunity to meet with them. Briefly reiterate - and I do mean briefly - why you are confident that you are a good fit for the position and their organization. Let them know that you remain very interested in the position. Close the note by indicating that you will follow up with them either by phone or email in a defined number of days, the usual is around one to two weeks. Hopefully you asked at the end of your interview about their timeframe for making the final hiring decision, this will help you decide how to time a follow up call or email. Just make sure that if you indicate you will follow up that you actually do follow through! Don't worry about seeming pushy. Hiring managers are used to receiving calls and emails following interviews. As long as you are polite and upbeat in any follow up correspondence you will leave a positive impression.

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The Gap After Graduation
December 16, 2015 8:53 AM by Renee Dahring
If you are looking for your first job you are probably wondering how much time will elapse from the time you graduate until you receive your first paycheck. Like most students you likely haven't been generating much income during your graduate program because your school demands have meant you haven't been able to work much or maybe not at all. In addition, when you factor your student loans in to the equation you are probably in negative territory when it comes to your finances. Oh, and did I mention the clock is ticking until you have to begin paying on those educational loans? It's not an understatement to say most new grads have some catching up to do. I'm sure you are feeling the pressure to get out there and start bringing in a salary ASAP.  

So realistically what are you looking at in terms of a timeframe? Let's review the steps that have to occur before you take your first paycheck to the bank. 

Everyone has to take boards. Even if you have a job secured you still need to factor in time to become certified. Some states have a special status that allows NPs to work after graduation and prior to certification, but in actual practice it rarely happens. In fact, I don't think I ever saw it happen. Why? You can't bill until you are credentialed and you can't be credentialed until you are board certified. Best case scenario if you submit your paperwork in to your certifying body promptly and your university verifies your status (which they can't do until after you graduate) you are probably looking at around 6-8 weeks post-graduation before you can even sit for your exam.

The next step is to be licensed as an NP in the state you will be working. Depending on your state you are looking at another 30 to 90 days. Some states are fairly speedy, but many are going to require verification from your school and all will ask for verification from your certifying body. These verifications must be sent directly to the board of nursing and so you are at the mercy of the turnaround time of each entity. If you are relocating or taking a job in a different state you also need to factor in obtaining an RN license in that state too. Thankfully that piece of the process is quicker, usually just a week or two.

Then you have credentialing. For the new practitioner this can also be a lengthy process and you can tack on at least another 90 days to complete this step.   

So what is the solution? For one thing, if you are working as an RN don't quit your job right after graduation! If you aren't currently employed, you might be able to negotiate working temporarily as an RN at your new place of employment before you start as an NP. Not ideal, but it will get you some income. It will also get you familiar with the EHR and the organization. 

So calm down, be realistic and plan for the "gap."
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Why Does Networking Matter?
December 2, 2015 10:05 AM by Renee Dahring
The old saying "it's not WHAT you know, but WHO you know" has been around a long time in relation to finding a new job. Over the years, networking consistently remains the number one way to find and land a job.

Having an inside or personal connection has always been a huge advantage to a job seeker and that is not likely to change. Of course in our profession WHAT you know is important too, but simply having the skills isn't always enough to get your foot in the door. 

Right now there are plenty of jobs out there, but you shouldn't let yourself be lulled into believing jobs are easy to land. In fact, in our current market the competition for each NP and PA position is quite strong and each job posted will attract dozens of applicants. To increase your chance of success, a personal referral can help you to stand out from the crowd of applicants. 

Why does networking matter? Employers have begun to mistrust the reference process. Laws prevent employers from disclosing truly helpful information about former employees. Job seekers also choose only references that they are confident will say positive things about their performance. That leaves potential employers with a rather biased sample with which to base their hiring decisions.

Everyone is on their best behavior during an interview so getting a real sense of the candidate's personality and how they might mesh with the current workplace culture is also tricky. I know a number of...umm... difficult personalities that initially present as quite amiable. Networking, while not perfect, does help to fill in the knowledge gaps.

Networking as a concept hasn't changed, but how we go about it is rapidly evolving. Networking in the good old days meant going to conferences or joining a professional organization. It meant staying in touch with former classmates and coworkers. In general it was a much longer process that one couldn't start just a few weeks before looking for a job. Those same methods are still sound strategies today so if that is what you have been doing I wouldn't advise that you stop. I would, however, advise that you add a digital component to your networking plan. 

Social media is the new networking tool and the great equalizer. You don't have to be limited to forging relationships with only people you have met in person. You can meet and connect online with employers and clinicians all over the country. 

Every platform, whether it's LinkedIn, Facebook or Twitter will allow you to reach out to others in your profession. Traditional mediums such as discussion boards still exist too. Join them all. But to be successful at digital networking you need to know it isn't enough just to sign up, you need to be engaged.

Lurking is not networking. You must be an active participant. That means posting comments and joining in the conversation. If you don't have a comment then ask a question. This is the "new networking" and the best way to find your next job.

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    Occupation: Nurse Practitioners and NP Recruiters
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