#1  Give adequate notice.
General standard notice is a minimum of 2 weeks, but often in a clinical setting 30 days is the norm.  Consult your contract or employee handbook for your practice's specific requirement.

#2  Write a resignation letter.
Resignations always look more professional if they are written or, if verbal, followed by a written notification that includes your last day of work. 

#3  Offer your assistance

Offer to help with the hiring process by networking to find a replacement.  Be available to train in the new provider if necessary.

#4  Don't get distracted
Stay on top of all your treatment plans and follow ups.  If you are drawing labs or ordering tests the last several days of work designate another provider who will follow up normal or abnormal results.

#5  Know what you're entitled to.
Check with your employee handbook and benefit information to find out what you're owed after you resign. You may be paid for unused vacation time or other benefits.

#6 Keep negativity in check

The medical community is often very small.  Make sure any complaints you may have are kept private.

#7 Stay in touch.
Networking is a great tool! Make sure your former employer and key colleagues have your contact information; get theirs, and use it to maintain good professional relationships.

#8 Send a Thank You
Send your boss and co-workers a thank-you note highlighting the positive aspects of your job. Co-workers will appreciate this nice touch, and it emphasizes they were working with a top-notch professional.

• May you come to the attention of those in authority
• May you find what you are looking for
• May you live in interesting times

Certainly the economy has played a role in the decreased number of NP jobs, but I think it may only be part of the story. I was listening to the radio the other day and overheard a radio personality voicing concern over the proposed "healthcare reform" bill. He said "you won't be able to see a doctor, you will be forced to see nurse practitioners or physician assistants because they are cheaper!"

No matter which side of the healthcare debate you fall on, this is a message that should be concerning to all NPs. We have worked hard to get where we are, and right now we cannot afford to let others define us as the "Wal-Mart" of healthcare.

For years we have touted our affordability as if it was a blessing, but it ironically could also become a curse and used against us. Certainly WE know we provide quality care at less cost, but have we adequately managed that message?

Maybe I am going all "black helicopter" here, but it seems to me to be more than a coincidence that as the economy has declined there has been a revived interest (and in some states blatant opposition) towards us from the AMA.

With healthcare reimbursement on the decline we are now beginning to find ourselves in more direct competition for patients and the scarce healthcare dollars that go with them, and in a position of having our physician colleagues now look at us as very real threats to their livelihood.

I am afraid we are indeed living in interesting times...

At first glance it sounds like a great way to get your resume in front of the greatest number of eyes with minimal effort, but do you know to whom those "eyes" belong?  Some boards allow anyone to search their resume databases, and others require the searcher to create an account and may or may not charge them a fee.  Either way you are giving strangers access to an awful lot of your personal information. 

So who are these "strangers"?  They may be HR representatives or hiring managers, but probably most are recruiters.  So the end result is that you have inadvertently engaged the services of a recruiter simply by posting your resume online.

Best case scenario, it's a reputable recruiter who matches your resume to your dream job and calls you for permission to pass on your information to a potential employer. 

Worst case scenario, the recruiter views your resume, thinks the match is close enough, passes it on to several employers and much like throwing spaghetti at the wall, hopes for something to stick.

On the other end, Potential Employer receives your resume, perhaps more than once AND possibly from more than one recruiter, and then proceeds to:

• wonder why you are applying for jobs that don't match your qualifications
  
• contact you, but since you had no knowledge that you applied for their position or that your resume has been passed on, you are completely unprepared and leave them with a bad impression
  
• are interested in interviewing you but put your resume on the bottom of the pile because if you are hired they have to pay the recruiter a fee
  
• received your resume so many times for so many jobs you are now invisible to them.
  
• any or all of the above

And don't even get me started on the risk of identity theft...

Interviewing for a new position may seem like a challenging task.  Following a few simple guidelines can make all the difference in how you present yourself.

Submitting a professional looking resume is the first step.  Be sure your address, phone, and e-mail are updated and your resume includes your current position.  Double check your resume for accuracy including dates of employment, and don't forget to use spell check.  Use a professional sounding e-mail, and make sure your greeting on voice mail is brief and clearly states your name. 

Potential employers will begin leaving messages by e-mail or phone to set up a telephone screen for their position. Return all messages promptly (within one business day), and express your thanks for the opportunity to meet with them by phone.  If you do take an employer call on your cell phone, make sure you are in a place to give the representative your full attention.

Prior to the phone screen learn as much as you can about the employer by visiting their Web site.  Jot down any questions that come to mind.  Clarify the time of the phone interview and who is to call whom.  For outstate interviews, remember to adjust for the different time zones.  When interviewing, find a quiet place that you will not be interrupted, and if possible, temporarily disable the call waiting feature to limit distractions.

After the phone screen, you will receive notification that your qualifications either match or do not match the position requirements.  If you are a strong match you will be invited to the on-site interview.  Confirm all times and directions with the interviewer prior to your interview date by either phone or e-mail, and be sure to end your correspondence by letting the employer know that you are looking forward to meeting them in person.

First impressions are very important in an interview.  Casual attire is inappropriate for the interview setting and should be avoided.  Skirts, slacks, blouses, suits and sport coats are all very safe choices.  In summertime women can avoid the pantyhose/bare leg conundrum that candidates are concerned about by simply wearing slacks. Safely accessorize your outfit by being understated rather than overstated.  The same goes for hair and makeup. 

Don't forget to follow up your interview with a thank you note, and call the employer directly to express your interest if you aren't hearing anything back after interviewing.  By following these few simple guidelines and visualizing a successful outcome, the interview process will be a breeze!

Lynn Schiff, NP, is the owner of Advanced Practice Solutions, a recruiting firm specializing in permanent and temporary nurse practitioner placements.  www.advancedpracticesolutions.com 

Start with a good support system and surround yourself with individuals who share your passion and bring goodness to your life. Now is a great time to connect with extended family or rekindle friendships that may have been put on hold while you were in school.

Reconnecting with yourself is important too! We all have things we love to do when we have time. Hobbies are very important stress relievers and as you begin to have a set routine with your new position try to make room for your hobbies. Life/work balance can be a juggling act at times, but making time for yourself will help keep you feeling refreshed and better able to manage life's curve balls.

Lastly, as NPs we are often looked to as leaders and good examples of healthy living. If your school schedule prohibited regular physical activity spring time and graduation is the perfect time to get outdoors and start moving again.

These are just a few simple ideas to help manage stress in the wake of change. Share your ideas on what you do for fun on our blog- we look forward to hearing them.

Difficulty finding a position seems the norm rather than the exception these days. Anxiety is on the rise as providers wonder if the healthcare cuts will affect them long term. Many are wondering if they should hold on to their current position while searching for that new opportunity. In today's economy, we strongly advise staying in a current position while evaluating jobs that match both skill set and passion. Do not leave a secure position until a formal written offer is received and the acceptance has been acknowledged. Some hospitals and healthcare systems are experiencing layoffs and hiring freezes, and it may be difficult to get your former position back if an offer falls through.

If you are unable to find a position in your area, continue to expand your network, and seek out volunteer opportunities in your specialty. Consider taking a short-term, temporary assignment during your job search.

The real estate market is showing some signs of life, so if you do find your dream position in a nearby town, selling your home is more likely now than 6 months ago. Try to be patient, and be thankful for the position you do have currently. The economy will eventually turn upward, hiring freezes will expire, and you will find your new job.

Lynn Schiff is a family nurse practitioner and the owner of Advanced Practice Solutions, a recruiting firm specializing in permanent and temporary nurse practitioner placements. https://webmail.finalasp.com/owa/redir.aspx?C=1447954818744351a55c2e0668dbd5d5&URL=http%3a%2f%2fwww.advancedpracticesolutions.com

So how does this relate to us as NPs? In today's world you don't have to be Paris Hilton or Brad Pitt to have an online "image." With the rise in popularity of social networking sites like Facebook and Myspace, our lives and our interests are increasingly becoming more public. So while we may be searching for a former classmate (or a camera review), employers are also logging on to see what information is out there on US when we apply for a job.

I counsel all NPs, even those not currently looking for a new job, to go online and "Google" themselves. Why? If your long-lost cousin can find out what you have been up to lately so can your patients. Yes, good and bad, they can read (and see) it all. We all have things we have done or said that are less than flattering that we may have forgotten we even posted. Or maybe we have interests and participate in discussion groups that there is nothing wrong with, but that we might not want everyone to know about because they may be very politically charged or even just a little silly. (Any Star Trek fans out there?) Also remember the Internet is still sort of the Wild West, and anyone with access to a computer can post anything they want about another person. More than one person has been surprised to learn that a "friend" posted that really goofy picture from spring break... you get the idea.

How to fix bad "PR"? Create new PR to replace it. If you can't delete it, add new content to your social networking sites to push back the older stuff. Some social networking sites also allow you to restrict access to your profile. Consider using a nickname or only your fist name when posting comments to public sites or discussion forums.

Now, go forth and Google thyself!

Assuming you are nationally certified and your certification and nursing license are in good standing, make sure they remain that way by working on continuing education and tracking and documenting previous and upcoming patient contact hours. For family nurse practitioners, comprehensive information on certification and recertification can be found on http://www.aanpcertification.org/ or http://www.nursecredentialing.org/ for NPs credentialed through ANCC. If your national certification has expired, you should contact the certifying body as soon as possible (especially if it has been less than 2 years) to follow their guidelines for certification.

Next, visit your state's board of nursing or nurse's association website to make sure there have not been any changes to the nurse practice act that you should be aware of. Often these sites will lead you to other helpful websites and resources you may not have thought of previously.

Hopefully, you have maintained a network of other APRNs in the area who are familiar with the current local job market and can point you in the right direction of finding employment.

If income allows, volunteer work is an attractive option for getting back into practice and getting something substantial on your resume. Alternatively, some practices are open to having an intern, and with a little networking you may be able to find a willing mentor who will help guide you through the transition back to practice.

Retail health may also be an option as it offers great flexibility, solid compensation, and a limited scope of practice, which some providers find helpful after an extended absence.

The type of practice you choose will ultimately depend on what is available and what fits with your own comfort zone. The best idea is to look honestly at your own skill level and find the opportunity that affords the best outcome for both you and your new patients.

I am in the job of helping NPs to find new jobs, so I hear on a regular basis why NPs are leaving their current jobs (it's one of the first questions I ask!), and I can attest to the fact that once a provider has lost that sense of purpose, the decision to quit is usually not far behind. It's not an easy decision, but they tell me they just can't take it anymore.

The complaints range from office politics, micromanaging supervisors, poor communication and general lack of support. Across the board I hear from NPs that they love their patients and they love being an NP, but the negative atmosphere simply just outweighs the positives they get from their patients. And now, the economy has only added another stressor to the mix.

So why am I writing this in a "Career Coach" blog? Because "recruiting" is only the first half of the story, "retention" is the other half. Many employers do retention well, there are obviously thousands of satisfied NPs out there that will never call me looking for a new job. I guarantee these stable work environments are no accident, these are folks that have taken a good hard look at their worksite and made it a priority to develop a healthy atmosphere.

Just say “non-compete” to a group of nurse practitioners and you will get a variety of reactions ranging from anxiety to confusion. Rarely does any NP feel confident when asked to sign a document chock full of legal jargon that has the ability to impact their future employment. The NPs I talk to tell me on one hand they feel uneasy signing but on the other hand don’t feel they have much choice but to sign. Not so different from the sinking feeling I got after filing my taxes today! The big difference of course is that when it comes to non-competes you DO have some other options.

First, remember that the purpose of a non-compete is to ensure that if and when you leave a practice you don’t take your patients with you to your new practice, it is not meant to prevent you from ever quitting. If you keep that in mind when reviewing a proposed non-compete it will make it easier for you to determine if the agreement is reasonable or not. Every employer has a right to protect themselves from financial loss, however, they do not have a right to restrict you so severely that you can’t find another job.

There are 2 major points I like to consider when evaluating a non-compete. The length of time they are to be in force and the geographical area impacted.

The length of time shouldn’t be excessive, in my opinion 6 months to a year is reasonable. The geographical portion usually stipulates that you can’t work within a certain number of miles of your current practice; after all it’s reasonable to expect you wouldn’t set up shop next door to your old practice. But on the other hand the geographical area you are restricted from shouldn’t be so extensive that you can’t even find work in or around the city where you currently practice. If your employer is part of large system that has several clinics, check to see if they are including those alternate sites in your non-compete even though you may never have worked in any of them. In my opinion that is not reasonable. Is there a standard number of miles? That depends on many factors but remember that number of miles you agree to will be the distance you will be forced to commute to your next job!

Bottom line; take some time, read the small print. Understand exactly what the restrictions will be placed on you when you are ready to move on to your next job.

And remember, it’s all negotiable!

Renee Dahring

The obvious is wages. Travel jobs are usually paid on an hourly basis, what most providers may not realize is that the hourly wage may not include tax withholding. What that means to you is that you will have to budget and pay your payroll taxes yourself. If you are like me and not too handy with federal and state IRS rules, you will probably need the services of an accountant to sort it all out and keep you on the right side of the tax laws.

Be sure to figure that cost into your assignment if you choose to go that route. Also be sure to ask how overtime and holidays are to be paid. Despite best laid plans, travelers very often do end up working overtime and holidays.

The next most obvious is travel and housing costs. If you fly, will a rental car be provided for you? Also ask about trips back home during your assignment. It's not unreasonable to ask for a set number of trips back home if your assignment is more than 6 weeks.

Find out what sort of housing is provided and how far it is from the facility where you will be working. I have seen everything from staying at an extended stay hotel to dorm-style living offered.

If a "per diem" is offered, review the IRS rates for the area you will be working. They may or may not be realistic to cover your housing expenses. Also know that asking for meal reimbursement while on assignment is not a reasonable request.

How about licensing and other fees? Are you or the employer responsible to pay costs associated with your licensing, DEA and credentialing? These can add up to a nice chunk of change and have to be completed before you can even start your assignment.

And who will carry your malpractice insurance? Will malpractice be your responsibility or the employers? If the employer agrees to cover any of these, will you be reimbursed before or after the assignment? If you leave the assignment early, will you have to pay it back?

Before signing on the dotted line, it's wise to make sure you have ironed out IN WRITING who is responsible for what so you can enjoy your time on the road!

I talk to several NPs every week who would like information about travel positions. Most NPs are familiar with travel nursing assignments but aren't so sure how that compares or applies to travel as a Nurse Practitioner so I thought I would write a few words about traveling as an NP this week.

The first thing we should mention is the terminology. We usually call these "locum tenens" jobs. Note that the word is "locum" not "local" (I wouldn't want you to mispronounce it while interviewing!). The term "locum tenens" is derived from Latin and means "a medical practitioner who temporarily takes the place of another." I don't know who thought we needed more obscure Latin terms in medicine!

You may also see these openings classified as "travel jobs" or "temporary jobs." Any of these terms typed into your search engine along with "NP" or "Nurse Practitioner" will turn up multiple results for you to review. As you will see there is no shortage of travel assignments, in fact during times of hiring freezes we often see more of these "locum" jobs.

Doing a travel position can be a great experience, but it's critical to do your homework first. Make sure whatever company is listing the position has a firm grasp on licensing. Unless it's a federal or government job, you will need to get a license in the state in which you intend to be working.

Be wary of anyone who tells you a getting a new state license as an NP is "no big deal" and that they can have ready to start in just a "couple weeks." I exclusively handled these assignments for our firm for several years, and my experience is that obtaining a license in another state is a process and usually averages about 6 to 8 weeks. Licensing requirements still vary greatly from state to state and may require official transcripts from your nursing program in addition to loads of other paperwork.

Some states require special licenses to prescribe, some even ask the applicant to take a "test" first or prove they have a certain number of hours of prescriptive experience before they can prescribe.

I believe at this time only three states participate in a NP compact (Texas, Utah, Iowa), meaning that these are the only states that honor licenses from each other. Unfortunately, holding an RN license in the state you wish to work in does not significantly speed things up.

More next week on travel...

Get ready to put on your detective hat because first you must find out what is the average salary for your area AND your specialty. Start your research by browsing job ads either online or in your local newspaper. Look for local salary survey information, many NP groups do annual salary surveys. If you feel comfortable, ask some colleagues about wages where they are working. You can also do some secret shopping and call a few medical facilities to get some general information.

Consider the cost of living in the area. What may be a great wage in rural Wisconsin won't get you too far in an urban area like Chicago or New York. Do some online research on real estate and rental costs to see what housing will cost. Don't forget to check on state, local and sales tax rates. Low tax rates can make a big difference in your bottom line.

Look at the whole package, high employer contributions to your 401K is like free money. How much CME reimbursement is offered? Does it include paid days off to attend conferences? Are they willing to reimburse for DEA and license/recertification? What medical coverage do they offer, what is the deductible, cost for dependants? How do you feel about vacation and sick days? For many of us having a good number of paid days off is worth its weight in gold and we will gladly opt for a little less hourly pay.

Ask about "production" pay or bonuses. For some of us this is unfamiliar territory, but it's been around forever for physicians. It can be quite lucrative but involves a little risk on your part so be sure if production is included you explore how patients will be assigned to you as a new provider. For a production-based system to work, you have to be sure you get a fair shot at the patient load.

And last but not least, also consider if this job is truly the one you really want, I always tell people to take the job they think they will love over one that pays a couple bucks more. All the money in the world won't help if the job is not a good fit for you.

"Dear Career Coach, I have been offered my first NP job. I have to admit I am a little disappointed with the salary ($34.78/ hr). The average salary in my area is $85,000. My questions are: What would be a fair salary? Should I counter? The position is part-time without benefits. I have been in the medical field since 1985. I would appreciate any advice you can provide."

This is a great question and very timely. This is a sort of "good news/bad news" scenario. First the good news, which is that you have been offered a job AND they are willing to take a new graduate.

The bad news, of course, is the wage is lower than you were hoping to see. This is actually a trend we have seen over the past couple months. On the one hand, employers are offering lower starting wages in general, but the upside is that they are becoming much more "new grad friendly."

However, this doesn't mean you are without options and have to take their first offer. I agree this salary seems low, and you have been wise to do your homework to find out what the average salary is in your area. A counter would not be out of line.

Making a counter-offer is hard for us as nurses, we aren't used to the back and forth negotiations over wages and benefits that is common in the business world, but our experience has been that most employers are expecting to receive a counter.

So how do you effectively counter? Just simply coming back with a higher wage demand is not likely to get you far unless you have some justification. In this situation I can see at least 3 areas you can use to your advantage: 1) The offer is not in line with the average salary in your area, 2) this is a part-time position with no benefits, generally you should see a slightly higher hourly wage offered to offset the fact there are no benefits, and 3) your RN experience.

Don't hesitate to heavily emphasize your years and experience as an RN. Your RN experience is generally your best leverage as a new grad when countering, especially if you can directly relate your past RN job experience to the job you have been offered.

How much to counter? That question is trickier. Look to my next blog for some thoughts on what factors to consider when looking at wages.

Did I mention we love questions? Email renee at onlineaps.com if you have suggestions or questions for us to address in our blog.

Every spring the University of Minnesota holds a conference for nurse practitioner students who are about to graduate. The topics addressed are various issues that students face as they are transitioning from student into practice.

Our company, Advanced Practice Solutions, always has a presence at this conference. We enjoy meeting and welcoming the next generation of nurse practitioners into practice. Since both Lynn and I attended this same conference when we were students, it reminds us of the excitement and anxiety that we felt as we were about to graduate.

Each year the job outlook for new grads changes, last year as we talked to the students we were somewhat amazed to learn that many, if not most, had job offers pending. In fact, there were more than a few students who were entertaining not just multiple offers, but multiple GOOD offers. Salaries and benefits were up, and new grads were starting near the higher ends of pay scales.

What a difference a year makes! As we suspected, the job prospects for new grads is not quite as sunny as in 2008. This year it was the exception to find a student who had a job waiting for them after graduation, but instead we had lines of students waiting eagerly to hear our take on the current market. Salary surveys are helpful tools, but they are retrospective in nature and as they say "past performance cannot predict future results." Those of us doing recruiting are on the front lines and see the trends in "real time" as they emerge.

So what advice were we able to tell these soon-to-be new NP's?

• Yes, we can confirm the market for new grads has tightened up since last year, and you shouldn't expect record setting salaries, but there are plenty of good jobs out there.
  
• Please keep an open mind about specialty practice, we are seeing somewhat of a decrease in family practice openings for new grads but specialty practices now seem to be very open to looking at a new grad practitioner.
  
• Be reasonable and fair when it comes to your salary requirements, we don't believe practitioners should be working below market but demanding in a recession to start at the top of the pay scale is not going to be an effective strategy.
  
• Be in it for the long haul because being prepared, working hard and getting some experience are still good investments.