Nursing School

Nursing as a second career: older nurses prove it’s never too late

Posted in Nursing Jobs, Nursing News, Nursing School

Alberta Hunter in her nurse uniform at Goldwater Memorial Hospital before her retirement in 1977

Alberta Hunter in her nurse uniform at Goldwater Memorial Hospital before her retirement in 1977

In 1955, blues and jazz legend Alberta Hunter decided to begin a second career as a nurse after reaching the pinnacle of a music and theater career spanning more than 4 decades.  Yet, she was turned down when she first applied to the School of Practical Nursing at the Young Women’s Christian Association branch in Harlem.   The director of the school told her that she was simply too old to become a nurse.  Undaunted, she applied again, this time with a fake birth certificate and high school diploma that understated her actual age by 12 years.   She then graduated from the YWCA LPN program in August 1956 and went on to work as a nurse at Goldwater Memorial Hospital in New York until she was forced by the hospital to retire in 1977 at age 82 (although the hospital staff actually thought she was 70).  By all accounts, she was an excellent nurse who was adored by her patients and coworkers and whom, during her 20 years at Goldwater Memorial Hospital, never missed a single day of work or was ever late to a shift.

These days, older nurses and nursing students have it much easier than Ms. Hunter.  While ageism and age discrimination is still as much of a problem in the nursing field as it is in other fields, it has clearly declined and older nurses and nursing students can expect a much more welcoming environment and workplace than they could have 60 years ago.

Operating room nurse Annell

Operating room nurse Annell

Annell Farris, the most recent winner of the Nursing Jobs Nurse Photo Contest, was 59 years old in 2008 when she graduated from the School of Nursing at John Hopkins University and began working as an operating room nurse.

In a recent Youtube video, Nurse Awesome outlined some of the advantages of being an older nursing student.

Nurses Mentoring Nurses

Posted in Nursing, Nursing News, Nursing School

September 17th, 2012
Jenna Fischer

Yuri Arcurs/ Fotolia

A pilot mentoring program based in Nevada is hoping to accomplish at least two things. First, help nurses figure out how to take their “book learning” from nursing school and put it into practice. The program also aims to help the experiences nurses who will serve as mentors to rekindle their own excitement about the profession.

The program is called the Nevada Nurses Association Mentoring project, and is sponsored by a grant from the American Nurses Association, according to this article on Nurses with at least three years’ experience and newly licensed nurses each complete profiles and then are matched according to compatibility. Then the mentor-and-mentee pairs communicate via email about any questions or concerns the mentees may have.

The time commitment is minimal — the article states that only 15 minutes a week for 8 weeks is required from the mentor nurses.

Nurses who have just graduated and are facing the real-life challenges of their first shifts often are left “without the parachute” of a classroom environment, said Denise Ogletree McGuinn, RN, APN, who is one of the mentors and the director of the program. “It’s a critical time,” she said. “They need someone who can take them by the hand and tell them what they’re feeling is normal.”

Networking can be difficult, especially in Nevada where vast open spaces separate large population centers. Nurses with questions about a particular specialty may have to travel a long way to mingle with someone in their field.

For experienced nurses it’s a chance to remember why they chose nursing in the first place and an opportunity to “rediscover our joy,” McGuinn said. For struggling nurses, she said having someone to turn to who is not a boss or co-worker can be “like a hot bowl of macaroni and cheese.”

By early September, 10 matches had been made and five mentors were awaiting mentees. McGuinn said they are hoping for at least 250 matches in the next month.

The hope of the program is not only to help nurses through the early years, but also to get them engaged in their profession and ready to help the people who come after them. “These are our leaders of tomorrow,” McGuinn said.

Making Time for Reflective Practice

Posted in Nursing, Nursing News, Nursing School

September 12th, 2012

Yuri Arcurs/ Fotolia

An interesting question was raised online in Nursing Times: Do nurses have time for reflective practice?

Reflective practice can be defined as reflecting on experiences in order to critically evaluate what you do well and how you might improve your personal nursing practice (i.e. skills, communication, interpersonal relationships, professionalism, beliefs, values and behavior). It involves the process of critical thinking. Nursing students are encouraged to perform reflective practice throughout their nursing education; in fact, reflective practice is often a formal component of nursing education in the form of journaling or other forms of writing that are evaluated by nursing instructors.

What happens when we graduate from nursing school and enter the “real world”? How many of us take the time to reflect critically on our nursing practice? How many of us have the time to practice critical reflection?

Some might argue that nurses are not allowed the time to practice critical reflection in the workplace. Many nurses are overworked, with too many patients and too few staff members available. Many nurses are focused on whether they will have time to break for lunch or visit the washroom, let alone take the time to engage in reflective practice.

However, reflective practice does not need to be as formal as it was in nursing school. Most of us engage in reflective behavior regarding our experiences as nurses on a daily basis, but don’t recognize that that is what we are actually doing. For example, when conflict arises with a patient’s family member, we may spend time thinking about how we responded to the family member’s criticism. We may take it a step further when we discuss the issue with our colleagues and ask their opinion about how we handled the situation, perhaps soliciting advice on how to better handle a similar situation in the future. We may grieve the loss of a patient to whom we had grown close, or dread the imminent loss, and spend time reflecting on how the relationship we formed with the patient was special or different from relationships with other patients, and why this particular patient moved us. We may engage in an informal debriefing session following a particularly difficult trauma in the ER, identifying ways to improve performance and what might have been done differently. These are all common scenarios and are examples of reflective practice, whether we think of them in that fashion or not.

The bottom line is that reflection does not need to be a formal process (although it can be if you prefer). As nurses, we constantly strive to become better practitioners. Just as formal continuing education is a requirement of the profession, so too is reflective practice. Reflection is a skill that we learn in nursing school that becomes engrained in our psyche.

We first learn the practice of critical reflection in the form of reflective activities and assignments that nursing instructors comment on, pointing out things we perhaps did not or would not have realized without someone’s greater experience. As we evolve in our ability to reflect critically in regards to our practice, our reflection becomes a reflex, a skill we have learned that we no longer think about consciously while performing, much like the physical skill of inserting an IV or taking a blood pressure reading.

Nursing and the New Face of Health IT

Posted in Nursing, Nursing News, Nursing School

As technology changes, nursing transforms its model of patient care. With the advent of personal digital assistants, smartphones, tablets and pocket-size computers, nursing has had to integrate new tools into its practice in order to provide better, safer patient care, improve patient outcomes, and communicate better with other members of the healthcare team.

The Institute of Medicine and the Robert Wood Johnson Foundation have released a landmark report, The Future of Nursing, Leading Change, Advancing Health, which issues recommendations for nurses to effect positive change in health care delivery. Each recommendation offers an opportunity to use IT tools to improve the quality, efficiency and safety of patient care.

Recommendation 1: Remove scope of practice barriers. Extending authority and reforming practice acts will enable nurses to receive incentive payments from Medicaid for “meaningful use of electronic health records” (EHRs) as provided in the Health Information Technology for Economic and Clinical Health Act, which is part of the American Recovery and Reinvestment Act of 2009. Under the Act, nurses are classified as “eligible providers,” which means nurses can use EHRs to collect and exchange patient information, resulting in better care and outcomes.

Oscar Espinoza -

Recommendation 2: Expand opportunities for nurses to lead and diffuse collaborative improvement efforts. Nurses need to take a more active role as leaders of healthcare teams, whether in research, design of practice environments, or sharing best practices. When implementing new technologies, nurses should track the impact the changes have on delivery of care in order to provide positive and negative feedback to the design team.

Recommendation 3: Implement nurse residency programs. Whether a nurse has just received her license or has earned an advanced degree, nurses need time to master the skills and knowledge of a new role. Technology can assist nurses in learning new competencies by using electronic patient simulation tools, which require critical thinking skills and psychomotor skills while providing experience with using EHRs.

Recommendation 4: Increase proportion of nurses with BSN degree to 80 percent by 2020. This goal represents a 30 percent increase overall in the number of BSN-prepared nurses. Distance learning is a valuable means towards this end, given its flexibility. Distance learning also reduces the cost factor of higher education, which enables more students to take advantage of educational opportunities.

Recommendation 5: Double the number of nurses with a doctorate by 2020. The faculty shortage in U.S. nursing schools is responsible in part for the nursing shortage today. Again, technology can help by offering online education opportunities as well as providing opportunities for information-sharing and collaboration.

Recommendation 6: Ensure that nurses engage in lifelong learning. In order to stay current in their field, nurses need to learn new technologies and competencies and integrate them into their practice.

Recommendation 7: Prepare and enable nurses to lead change and advance health. All nurses need to embrace technology, whether it is being used at a patient’s bedside or in a nurse leadership position. The nurse informatician must take the lead in a strategic and operational role to bridge the gap standing between clinicians and technology. The nurse informatician gathers input from clinicians, designs an efficient workflow and tracks the results.

Recommendation 8: Build an infrastructure to collect and analyze healthcare workforce data. Data that is not organized in the best possible way wastes time, effort and money. Nurses need to keep an eye out for inefficiencies and either propose change themselves or seek out experts to keep an organization’s IT systems current.

The recommendations in this report have been a sort of call to action for the 3 million nurses in the U.S. to embrace and integrate health IT into their daily practice. The long-standing goal of health IT has always been to improve patient care and outcomes, but it can also affect nursing education, research, leadership and policy, ultimately improving nursing as an art and science.

Gaming as Training for Nursing Students

Posted in Nursing, Nursing News, Nursing School, Nursing Specialties

Serguei Kovalev -

Practice makes perfect and nobody is a perfect nurse right away. So it would be nice if nurses could make their rookie mistakes on virtual patients rather than real ones. The University of Minnesota School of Nursing is helping to develop a bunch of computer games that allow that kind of practice for nursing students, the Minnesota Daily reports.

A clinical professor at the U of M named Tom Clancy (apparently no relation to the novelist) is working with the software company VitalSims and local hospitals to develop serious educational tools that would take their place alongside similar tools used by the military, for example.

Simulation is not new in health care — many nursing schools have fancy robot “patients” that are getting more and more sophisticated. They can be mighty expensive, though.

Games are more cost-effective and are able to provide an extremely wide variety of practice situations. Users can train for really complex situations or stick to the basics, according to their needs.

Clancy said gaming is not set to replace any of the familiar components of education, but it will supplement book work and lectures.

“Every time you go from one modality to another, you’re doing a different kind of learning,” he said. Clancy said adding gaming to students’ curricula may seem inefficient, but it reduces the time needed in other educational settings. VitalSims’ CEO Chris Duncan cited a 2008 study that showed serious gaming to assist information retention 91 percent more effectively than lecture attendance.

“We’re still trying to tease out exactly how to implement gaming in education.” Serious gaming is, Clancy said, “in its infancy.”

The game

Clancy opened an early version of his program and chose “Myocardial Infarction” (heart attack) from a list of injuries and ailments on the game’s main menu.

“You’ll have to excuse the graphics; they’re kind of old,” Clancy said.

The heart attack mission opens with a cutscene, or non-interactive scripted event, in which two identical nurses banter before entering the emergency room.

Soon after, they enter the ER, and from then on it’s strictly business. The game is played from a first-person perspective, with the player positioned over the patient. Intense music accents the time pressure, as do occasional comments from the assistant nurse.

There is a “toolbox” at the bottom of the screen in which the player selects from an array of instruments divided by category.

Clancy used his magnifying glass by finding it in a sub-menu and dragging it to the patient’s mouth. When he determined she wasn’t breathing, he opened a another menu, equipped an oxygen pump and selected the appropriate rhythm from a list. He then equipped a heart monitor, which brought up a cardiogram on the side of the screen.

“That rhythm,” Clancy explains, “happens to be very deadly.”

Next he demonstrated the scoring system by purposefully administering random drugs and using incorrect instruments. The patient eventually died.

These games will include multiplayer and cover a wide variety of cases, hopefully ensuring that students are given breadth of experience, Duncan said.

He said cultural considerations are also planned, such as settings that account for different languages and religious beliefs, which will help make it more accessible. There will also be leaderboards, which Clancy said he believes will encourage students to improve through competition.

‘The way of the future’

The new games are part of a growing trend of using gaming for professional development.

Linda Olson Keller, another professor of nursing at the University, is supportive of Clancy’s and the MHA’s project. She described a similar initiative by the U.S. Centers for Disease Control and Prevention to use games to promote public health. One game, called HealthBound, challenges players to solve health-related problems and then scores their results and encourages them to get involved in various community programs.

Another, from the Chicago Department of Public Health, is designed to prepare players for a possible anthrax outbreak.

Keller described this method of education as “the way of the future.”

Clancy foresees games becoming commonplace in other fields.

“We’re seeing this continuum of different ways of education, and gaming has its place in here now,” he said. “We’re still learning where exactly that place is.”

Teaching Empathy

Posted in Nursing, Nursing News, Nursing School

Lisa F. Young -

A health care professional may have the best possible technical skills, and encyclopedic knowledge, but one more element is needed to be truly effective: empathy.

Studies have shown that this important attribute has been declining amongst nursing and medical students. The benefits of empathy go far beyond the exam room. Greater empathy levels is associated with fewer medical errors, better patient outcomes, more satisfied patients, and fewer malpractice claims.

Traditionally, empathy has been thought to be inherent — you have it, or you don’t. This article in the New York Times looks at some of the new research that indicates that it can be taught.

Building on research over the last decade that has shown that empathetic observers have brain activity, heart rate and skin electrical conductance that mirror those of the person undergoing the emotional experience — observing a friend’s hand getting slammed in a car door, for example, causes us to flinch because an image of the accident gets mapped onto the pain and threat sensors in our own brain — Dr. Helen Riess, director of the Empathy and Relational Science Program in the department of psychiatry at the Massachusetts General Hospital in Boston, created a series of empathy “training modules” for doctors. The tools are designed to teach methods for recognizing key nonverbal cues and facial expressions in patients as well as strategies for dealing with one’s own physiologic responses to highly emotional encounters.

In one lesson, for example, doctors watch a video of a tense exam room interaction while a striking graphic sidebar records the electrical skin conductance of both patient and doctor, the mismatched spikes peaking as each person’s frustration with the other escalates. Another lesson walks doctors through a series of pictures of a patient whose face expresses anger, contempt, happiness, fear, surprise, disgust or sadness.

To test the effectiveness of the lessons, Dr. Riess and several of her colleagues enrolled about 100 doctors-in-training and asked their patients to evaluate their empathy, based on the doctor’s ability to make them feel at ease, show care and compassion and fully understand patient concerns. Half of the doctors then took part in three one-hour empathy training sessions.

Two months later, the researchers asked a second group of patients to evaluate all the doctors again. They found that the doctors who had taken the empathy classes showed significant improvements in their empathetic behavior, while those who had not actually got worse at empathizing with patients.

“People tend to believe that you are either born with empathy or not,” said Dr. Helen Riess, lead author of the study. “But empathy can be taught, and you can improve.”

Compared with their peers, doctors who went through the empathy course interrupted their patients less, maintained better eye contact and were better able to maintain their equanimity if patients became angry, frustrated or upset. They also appeared to develop resistance to the notorious “dehumanizing effects” of medical training. After the empathy classes, one physician who had complained about being burned out said, “I feel as though like I like my job again.”

Responses to this study have so far been enthusiastic, in part because it is one of the first to rely on patient evaluations of empathy rather than physician self-assessment. “The holy grail of this kind of research is whether patients think doctors are empathic, not whether the doctors think they are,” Dr. Riess said. She and her colleagues plan to expand their research and offer the training to more doctors, as well as to nurses, physician assistants and others.

“We are in a special place in the history of medicine,” she said. “We have the neurophysiology data that validates and helps move medicine back to a real balance between the science and the art.”

Curious to know whether the empathy course worked, I decided to try out what I had learned in researching this column. The next day at the hospital, I took extra care to sit down facing my patients and not a computer screen, to observe the changing expressions on their faces and to take note of the subtle gestures and voice modulations covered in the course. While I found it challenging at first to incorporate the additional information when my mind was already juggling possible diagnoses and treatment plans, eventually it became fun, a return to the kind of focused one-on-one interaction that drew me to medicine in the first place.

Just before leaving, one of the patients pulled me aside. “Thanks, Doc,” he said. “I have never felt so listened to before.”

UC-Davis Graduating First Class of Nurses

Posted in California, Nursing, Nursing Jobs, Nursing News, Nursing School

russelllinton -

Five years ago, philanthropist Betty Irene Moore donated $100 million to the University of California – Davis, moving the School of Nursing from dream to reality. This week, the first group of nurses will graduate from the program.

25 students who were recruited for their talent and whose education was fully funded by scholarships will be graduating. The hope is that they represent a new breed of well-educated nurses who will transform the health care system.

In this article in the Sacramento Bee, the School of Nursing Dean Heather Young said, “Our goals and priorities are to improve the health care system and advance the health of our communities. We realize that nurses can, and should be, the catalysts of change.”

Young called this year’s class of graduating nurses “just a beginning.” Already another 25 students are queued up for the next two years, with more than 30 percent of them coming from underrepresented ethnic communities. The school also enrolls doctoral students in a four-year program.

In a seminal 2010 report on the future of nursing, the Institute of Medicine concluded that health care reform meant “nursing education must be fundamentally improved both before and after nurses receive their licenses.”

With the population growing older and chronic diseases taking center stage, the IOM report, which Young endorses, determined that “nurses should achieve higher levels of education and training through an improved education system that promotes seamless academic progression.”

Young said she was drawn to the position of dean because she, too, was inspired by the vision of Betty Moore.

The story of how Moore decided to commit $100 million over 11 years to a new school of nursing is a tale of personal belief in change.

Moore had been in a hospital and experienced a medication error. A nurse had insisted she take a shot, but Moore objected. The nurse gave her the shot anyway.

It turned out the shot of insulin was meant for a neighboring patient and potentially put the health of both patients at risk.

Says nurse Johnston, “What impresses me most is that Betty Irene Moore, a person with a lot of money, didn’t go blaming the individual or the system, she did the opposite. She decided she could do something positive about the problem of medical errors, make change for the better and build a better nurse.”

Specifically, Johnston’s job, which he says is a project of the Gordon and Betty Moore Foundation, is to be an educator, a monitor and a resource to prevent patients from getting hospital-acquired infections from improper use of ventilators, intravenous tubes, catheters and the like.

In the status-quo health care system, such infections have come to be seen as somewhat of a statistical inevitability – even to the point where patients’ rights groups routinely tracked and reported their occurrence in various hospitals.

“The culture and belief that infections are a part of a hospital stay needs to change,” Johnston said.

In an interview at the UC Medical Center where he works, Johnston said his job is called “nurse champion.”

He works as part of a collaborative system for higher quality by advising and teaching medical staff on ways to curb hospital infections.

It’s a challenging and new role for Johnston, who’s worked as a nurse for 5 1/2 years.

“We are colleagues with physicians and nurses and aides,” he said. “We are change agents in the system.”

To be sure, Johnston’s gotten some push back already in his new job in the UC Davis Medical Center’s burn unit. But he’s prepared to tap into the communication and leadership skills he’s learned to overcome the skepticism.

“I was seen as an outsider, someone to audit them and get them in trouble,” Johnston said of his colleagues. “There was some question of my credibility and credentials both from nurses and the physician side. It’s a challenge. It takes time to get that buy-in.”

National Nurse’s Week: One Nurse’s Story

Posted in Nursing, Nursing Jobs, Nursing News, Nursing School, Nursing Specialties

Robert Kneschke -

In honor of National Nurses’s week, Sherry R. Siegel, R.N., M.S.N., C.H.P.N, is featured in an article on, relaying her story of being a nurse over the past twenty years.

Her story begins more than 20 years ago when she was a single mother with two children and lots of bills to pay. She was a waitress at the time and actually enjoyed that job, but the pay was not enough to give her family financial security (or health insurance). So she contacted a nearby college and asked the admissions counselor there what agree would be most likely to actually assure her a job. As a waitress she knew many people with college degrees who were nonetheless unable to find jobs in the area they had studied.

The admissions counselor told her, “Be a nurse. You’ll always have a job.” She took that advice, and enrolled in the college, graduating two years later with an associate degree in nursing.

She quickly found a job as a nurse, with a steady paycheck and health insurance, and then also discovered that she loved being a nurse.

My first nursing job was in cardiology and then I moved to home care. After a few years I became a hospice nurse, which was where I needed to be. I loved being a hospice nurse and became passionate about a good end-of-life experience for everyone. I believe in the hospice philosophy of living as well as you can for as long as you can. Isn’t this what everyone wants?

After 10 great years, I left hospice to become the palliative care coordinator at The Regional Cancer Center. I had learned so much during my time as a hospice nurse and hoped that I could use my skills and knowledge to help cancer patients maintain their quality of life while facing a life-threatening disease. While working with cancer patients and caregivers can be challenging and emotionally draining, it can also be rewarding. Cancer is a heartbreaking word and a life changing event for patients, their families and caregivers. Much can be done to address pain and suffering throughout the cancer journey if we take the time to listen.

As a palliative care nurse I provide symptom management and extra support to patients and caregivers. Patients who have their needs met have fewer psychosocial issues, such as depression, stress and worry, and are more likely to complete their cancer treatments. This allows patients with a life-threatening disease to live as well as they can for as long as possible.

Twenty years ago when I decided to be a nurse I never dreamed where this journey would take me. I have since received bachelor’s and master’s degrees in nursing and became certified in hospice and palliative care.

I love being a nurse and knowing that the little things I do to improve quality of life makes a difference. Nurses are members of the largest health care profession and the ones who have the most contact with patients and their families. This makes us, as nurses, the front line for advocating for patients and families in a very complex health care system. Every day we have an opportunity to make a difference. Let’s recognize these opportunities, and then use our skills and knowledge to make a difference.

Happy Nurses Week to all fellow nurses. Go out and do what we do best: Care!

More Nurses to Be Trained To Treat PTSD, TBI

Posted in Nursing, Nursing News, Nursing School, Nursing Specialties

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The White House is leading an initiative to improve health care for former troops and their families. The White House’s Joining Forces campaign includes an agreement with 150 nursing organizations and 500 nursing schools to educate nurses on combat-related injuries.

There will be additional coursework and training opportunities regarding injuries such as post-traumatic stress disorder and traumatic brain injury.

The effort aims to reach 3 million nurses on the “front lines of health care,” as Joining Forces Director Navy Capt. Bradley Cooper is quoted as saying in this article in the Air Force Times.

“The goal is to raise awareness among every nurse throughout the country to recognize the signs and symptoms and lower the stigma of getting care,” said Amy Garcia, chief nursing officer for the American Nurses Association.

The White House estimates that 300,000 Iraq and Afghanistan veterans suffer from traumatic brain injury, PTSD or other combat-related mental health issues, such as depression.

About half have sought care from the Veterans Affairs Department, leaving about 150,000 former service members seeking civilian care, Cooper said.

Joining Forces is a campaign designed to raise awareness of the needs of military personnel, veterans and their families. It was launched a year ago this week.

Obama and Biden will unveil more details on the new initiative when they speak Wednesday at the University of Pennsylvania School of Nursing.

In January, Mrs. Obama announced a similar pledge by 135 medical schools to educate future physicians and increase research on what are commonly referred to as the “invisible wounds” of war — PTSD and TBI.

Garcia said no federal funding is being used for the effort.

According to Garcia, one out of every 100 Americans is a nurse. Many don’t work in fields where they would be exposed to head injury or behavioral health disorders. Educating all nurses on these injuries and illnesses would lead to better veterans’ care, she said.

“We want to make sure they understand about new treatments and new science so they can make appropriate referrals,” Garcia said.

The professional education and training opportunities that will be offered through the initiative will be voluntary, she added.

Importance of Letters of Reference for New Grads

Posted in Nursing, Nursing Jobs, Nursing News, Nursing School

© Yuri Arcurs -

When new nursing school graduates are out looking for jobs, interviews are frequently the deciding factor as to whether they will be hired or not. But in this article on about the importance of letters of recommendation, one person who makes these kinds of decisions, Linda Bell RN-C, says that she is given pause if a reference letter does not match up with an excellent interview. “Then I’ll wait and see other candidates,” she says. “I have to see a solid level of professionalism when the candidate was a student.”

Recruiters are looking for qualities similar to the ones that were important in nursing school, such as respect for the profession of nursing, cultural competence, reliability, and the ability to perform in high-stress situations. These sorts of attributes can be highlighted in effective letters of recommendation.

Today’s competitive job market gives recruiters a choice to hire seasoned nurses instead of new graduates, but some still choose to hire new nurses. Anna Tigar, RN, an experienced nurse manager who supervises a fast-paced, 17-bed medical unit at NSLIJ Health System/Lenox Hill, said she is proud to uphold a policy of hiring new graduates.

“New grads deserve a break and a chance to succeed, and I like being able to role model my nurses for them,” Tigar said. “The qualities I’m looking for are initiative, commitment to safe practice, great character, personal ethics and potential for leadership because all of this makes a great nurse in the end. I don’t care if you ace all your exams. I may look over 100 letters a year so if I don’t see those qualities spelled out, I’ll pass on to the next person.”

But nursing graduates are not expected to perform as expert nurses. “I’m willing to teach skills, and for new grads [those include] time management and setting priorities, but I won’t teach you how to conduct yourself as a professional and compassionate RN,” Bell said.

Students should remember that letter writing is important on many levels. A prompt thank you note after an interview is an expected courtesy and a simple way for applicants to stand out from a large pool of qualified graduates.

“It’s a nice touch to receive a letter back from candidates,” Bell said, “because I do spend a lot of time with them, at least an hour and sometimes, two hours.”

Network strategy

In the past, many nursing students had job offers lined up before or directly after graduation. But today, months may pass as new graduates wait for their applications to be processed and interviews granted, so innovative pathways to practice, such as nurse residency programs or externships, should be considered. Such programs are highly competitive, and solid letters of recommendation have the potential to help new graduates secure a position.

Geraldine Varrassi, RN, EdD, nurse educator at NSLIJ Health System/Lenox Hill, oversees the Hillman Nurse Residency Program, a unique opportunity for students who have not yet passed the NCLEX to team up, full time, with a volunteer RN for eight weeks. She stressed the importance of the letters of reference as an integral part of the admissions process.

“This is a highly competitive program, with [more than] 300 applicants a year,” Varrassi said. “We choose 20 students and our criteria are very high. Make no mistake, after the GPA is reviewed, we read through every reference letter and only then would we offer an interview. The letters of reference are extremely important and you should start thinking about them as part of your network experience in nursing, and that begins the first day that you enter the program.”

Forming and maintaining professional relationships with instructors is an important step to securing letters of reference and is an important workplace skill. Varrassi shared some basic points students should follow.

“The way to obtain a positive reference letter is stay in touch with professors, not on a daily basis, but drop them an email, let them know how you are progressing in your courses, send a holiday card,” Varrassi said. “You may want to use this person again, even after you graduate, so it should be an ongoing relationship. Ideally, the letters are written by someone who knows you well, not the clinical instructor you had last month. I want to see that they are familiar with your achievements.”