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Career Development-First Step: First Nursing Position
Career development is a responsibility of every nurse. This process really begins before graduation from a nursing program and completion of licensure requirements.
From Student to Practice: Reality Shock
Reality shock has been identified in nursing as the shock-like reaction that occurs when initial education comes in conflict with work-world values (Kramer, 1974). Another definition is “the incongruency of values and behaviors between the school subculture and the work subculture that leads to role deprivation or reality shock” (Schmalenberg & Kramer, 1979, p. 2). Benner (1984) identified five stages of competence: novice, advanced beginner, competent, proficient, and expert. The first three stages are affected by reality shock. Through the nursing education process, the novice nurse learns the rules for performance but has limited real-life clinical experience during which to apply those rules and to expand clinical reasoning and judgment.
Getting your first job as an RN is a very important step in your career development. Even before graduation, you should take some time to begin a career plan. The plan will change over time, but having a plan provides a guide for personal professional decisions.
Tools and Strategies to Make the Transition Easier
Where to begin? You should begin by developing a résumé, composing a biosketch, and maintaining a professional portfolio. A résumé is a one- or two-page document that describes your career. It includes your name, contact information, credentials, education, career goals and objectives, and employment and relevant experience (a résumé should be kept current and not be lengthy). The biosketch is a paragraph that provides a short summary of your work history and accomplishments. It should include your name, credentials, and education. It is a narrative rather than a list. Later, curriculum vitae can be developed particularly if you apply for an academic position. This is a more detailed accounting of information found in the résumé and includes publications, presentations, continuing education (CE), honors and awards, community activities, and grants. Sometimes practice employers want this type of information.
The portfolio provides evidence of a person's competency. It is not always required for job applications, but sometimes it is, and in some positions, nurses are asked to maintain a portfolio for performance review. Some employers provide a system for online recording of this information that staff update. A portfolio is a collection of information that demonstrates experiences and accomplishments, such as committee work, professional organization activities, presentations, development of patient education material, awards, letters of recognition, projects and grants, and so on. The portfolio should include annual goals and objectives and review of outcomes, which should be updated annually.
A professional development plan, which is based on information found in your résumé and portfolio, lays out the direction you want to take with your career over the next year, two years, and five years. It should include a target time frame and strategies and activities to reach your goals. Self-assessment is a critical activity for any nurse, and this assessment helps you to further develop the career plan.
Interviewing for a New Position
Interviewing for a new position as a nurse should be taken seriously. The first step is setting up the interview. As the potential employee, you should find out the time of the appointment, the location, and the length of the interview. Will there be more than one interview on the same day? Will additional interviews take place later depending on whether the person is considered for the position? Will the interview be with one person or with a group and with whom? Do your homework; find out as much as possible about the healthcare organization (HCO) and people who will be at the interview and think about the types of questions they might ask you and how to respond to them. Internet searches can provide a lot of information about HCOs and individuals who will interview you. Wear business dress, look neat, and be prepared. Bring a copy of your résumé to all interviews and any other required documents. Make sure you know how to get to the interview and parking options if driving and arrive early to allow yourself time to focus on the interview. Delays can happen when you least expect them, so planning to arrive early helps to prevent lateness.
During the interview, focus on the questions. Look the interviewer in the eye, take a moment to respond, and ask for clarification if you are unsure about the question. Share information about competencies and experiences-successes and challenges, and how you handled them. Ask the interviewer about the organization and the position (see Exhibit C-1).
| Exhibit C-1 Examples of Questions to Ask During an Interview for a Hospital RN Position |
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Additional guidance about information job candidates may need is discussed further in the following information.
Determination of the Best Fit: You and a New Position
How does one choose a position and an organization for employment? It is not easy to know that the fit is a good one. First, know which type of nursing interests you and why. Second, based on what you know about the HCOs in the location where you want to work, focus on those organizations that most interest you. Today, the internet is a resource for job hunting. Most HCOs, particularly hospitals, have websites. Explore them to learn about specific HCOs. Talk to people who may know about the HCOs that interest you. If you are planning to move to a new location, then factor in that you need to know more about the location-housing, transportation, community, and so on.
Students often have clinical experiences in several HCOs, and they can use this opportunity to assess each organization. Do staff members seem happy working there? Does the HCO differentiate degrees in nursing and how? What is the quality of care, communication, and so on? What are some of the negative aspects of the organization?
Salary and benefits are always an important factor. Potential employees should also consider driving distance or other transportation issues, parking, schedules, and general work conditions. Asking about promotions and use of career ladders can yield helpful information, along with how much support is given to staff for education (that is, orientation, staff education and development, and pursuit of academic degrees). Regarding education, a potential new employee should ask if tuition reimbursement is available and for which staff level. Is it difficult to get release time to attend classes, or is there flexible staffing to allow for this?
Nurses should also ask about staff turnover, use of supplemental staffing (agency and travelers), and change in nurse leaders. HCOs that experience high turnover in staff and nurse managers are organizations that are experiencing problems. Overreliance on supplemental staff indicates that the organization is having problems retaining nurses and developing strategies to cope with a nursing shortage. (Nursing shortages vary and may be HCO specific, local, or national.)
Is the HCO used for clinical experiences for nursing students? This usually means that the organization is interested in education, but it also means that staff members need to be willing to work with students. How is medical staff coverage handled? Are there medical students and residents? It is important to know who covers for medical issues because this has an impact on expectations of nursing staff and collaboration with others.
Today, hospitals are ranked locally, by state, and nationally. This information can be accessed through the internet.
The HCO's top leadership, such as the chief executive officer (CEO), is an important person. The CEO signs off on the budget. If the CEO does not recognize the importance of nursing to the organization and to outcomes, this can have a negative impact on how nurses are treated. It can affect budget issues such as the number of nursing positions, salaries and benefits, and funds for education. The CEO works closely with the nurse executive who represents the nursing staff.
Mentoring, Coaching, and Networking
Several methods are used in HCOs to support new staff, and mentoring is one of them. The mentor is more experienced and usually selected by the staff nurse, but some HCOs assign new staff to mentors. The mentor acts as a role model and serves as a resource. Coaching is another method used for support, encouragement, and career development (for example, how to prepare for a promotion or for career ladder level changes or to go back to school for a higher degree).
Networking is a less structured method. All nurses need to learn how to network or make connections with nurses and others who can help them. Professional organizations are good places to network and meet nurses who might provide guidance, support, and/or information. Nurses should keep contact information of potential connections even when they may not have a specific reason to make the contact; one never knows when this information may become important. Networking can also be done in non-healthcare settings that include people who may be helpful to know.
Career Ladder
Many HCOs today have developed career ladder programs for their nurses. The details of these career ladders vary from organization to organization. Typically, there are levels such as Clinician I, II, III, and so on. The first level is entry level. The levels describe the role and responsibilities, as well as the educational requirements for that position or level. This type of system provides clear criteria for promotion and an increase in salary that does not require moving to a management position, which in the past was the most common path for advancement. The career ladder structure recognizes that clinical work is important and deserves recognition. Nurses need to demonstrate they meet the criteria for the level that they are requesting. This is the point at which a nurse might use a portfolio and mentor. In some HCOs, portfolios are required for promotion. Along with identified criteria, HCOs need clear procedures for staff members who want to apply for a change in level within the career ladder system.
Encouraging staff to participate in the career ladder offers positive outcomes for the organization, such as motivating staff to improve their competencies and increase their education level, increasing efforts to improve care, serving as an attractive recruitment strategy, and increasing retention. Performance improvement should be an active part of any nursing position. Through an active, positive performance improvement program, staff can use self-assessment and assessment from supervisors to further develop their career plans.
Going Back to School, Certification, and CE
Returning to school for another degree may not be your first thought after graduation and licensure, but when you develop a career plan, additional education should be considered based on your goals and timeline. You need to consider the best time to begin work on additional education. Competency is an important issue. Do you need more time to achieve competency and to further your development as a professional nurse before entering a graduate program or a specialty? Some specialties may require a certain type of practice experience before entering a graduate program-for example, nurse anesthesia programs require practice experience in critical care. Entering such specialties requires serious thought and planning. Additional education is most productive when you are competent at your current position level and practice effectively as a professional nurse. For many new graduates, achieving this level of competency takes time.
Certification is another way to expand competencies and education; however, it does require that you have a specified amount of experience before taking a certification examination. Thus, you need to plan when to apply and obtain the required experience. Certification can be obtained through ANA and specialty organizations; see the organizations' websites for specifics about certification per specialty.
Continuing professional education (CE) is a professional responsibility. Employers may provide educational experiences that also allow nurses to earn CE contact hours, or they may cover expenses for staff to attend CE programs outside the HCO. Many professional organizations offer CE programs, and many are now web-based programs. Some states require their licensed RNs to earn a certain number of contact hours prior to relicensure. Certified nurses must meet CE requirements to continue their certification. CE is more effective if the content relates to the work that the nurse does and is in alignment with the nurse's professional goals. Nurses should keep a file of CE activities and update their records accordingly.
- BennerP.(1984). From novice to expert: Excellence and power in clinical nursing practice. Addison-Wesley.
- KramerM.(1974). Reality shock: Why nurses leave nursing. Mosby.
- MilsteadJ., & FurlongE. (2008). Handbook of nursing leadership: Creative skills for a culture of safety. Jones & Bartlett Learning
- SchmalenbergC., & KramerM. (1979). Coping with reality shock. Nursing Resources.
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