As competition for new graduate nursing positions grows, it may be wise for students to keep common etiquette and professional standards in perspective during their years in college. Often students who have demonstrated a high level of professionalism throughout their school career — in the classroom and during clinicals — are the ones who get hired.
“Great interviews will often be the deciding factor when I choose my nurses,” said Linda Bell, RN-C. who oversees a 37-bed medicine unit at North Shore-LIJ Health System’s Lenox Hill Hospital in New York City, which may require her to hire 10 to 12 new nurses a year. “But sometimes the reference letters do not match up. Then I’ll wait and see other candidates. … I have to see a solid level of professionalism when the candidate was a student.”
The qualities instructors expect of nursing students mirror the attributes recruiters seek in new graduates, such as respect for human life and the profession of nursing, cultural competence, reliability and the capacity to perform in a high-stress arena. These professional behaviors are the basis of positive, personalized 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.North Shore-LIJ Health System/Lenox Hill Hospital nurses, from left, are Anna Tigar, RN; Linda Bell, RN,C; and Geraldine Varrassi, RN.
“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 strategyNoreen Nelson, RN
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.”
What to expectSusan Lombardo, RN
Bell and Varrassi stress students should be specific when asking for letters of reference. Remind the instructor of the time when you made a significant difference in the care of a patient. The nurses said superlatives often are over-used in letter writing and may ring hollow unless backed up by specific examples.
“A detailed scenario is always the best way a teacher can describe the superior qualities of a candidate,” Bell said. “For example, maybe this student handled a difficult situation with extraordinary tact and knowledge, as in helping a patient and their family cope with a new diagnosis of cancer or diabetes.
Many nursing instructors receive dozens of requests for letters a year and the task of writing individualized recommendations may become daunting. “I know instructors who have A, B and C letters in their files and just pull them up depending on the student. I don’t want to do this,” said Noreen Nelson, RN, PhD, a clinical instructor at the New York University College of Nursing. She said she sometimes limits the number of letters she writes because providing a personalized, quality letter becomes quite time consuming as volume increases.
Nelson said she believes students must be proactive and maximize their learning opportunities if they expect positive references. “It’s much easier to write letters for students who have consistently self-evaluated their strengths and weaknesses throughout the program,” she said. “When it comes time to write an individualized letter, student input is important as it allows me to contrast their self-perception with my assessment of the student.”
Nelson recommends students keep a reflective journal to make the task easier. Within this framework, students then can identify why they should be hired and what makes them special.
A trend by human resource departments is to emphasize student conduct and team values before academics, said Susan Lombardo, RN, PhD, a clinical assistant professor of nursing at NYU College of Nursing. “Many employers are now asking first and foremost how students relate to others, how they are able to work in groups and how much they are committed to the profession,” Lombardo said. “My advice is [that] from the beginning the student should be building on not only knowledge, but [also] behavior. Nursing is a caring profession and one that I take seriously. I would expect that students be open-minded, caring and compassionate.”