Outstanding nurses develop in an environment that supports excellence and encourages professional growth. Therefore, selecting a workplace is an important part of career planning. Whether you're a new nurse looking for your first job or an experienced nurse looking for a different position, it pays to set aside time to think about your professional goals and what kind of workplace will help you to meet them.

SELF-ASSESSMENT

Self-assessment ideally begins before you fill out an application or talk with a potential employer. The more you know about yourself and your goals, the easier it will be to choose the best job.

The following questions and suggestions may help you define your career goals. Be honest with yourself, and put your answers in writing.

* Where do you want to be at this time next year?

* Where do you want to be in five years?

* Which degrees, certifications, or training programs would you like to complete?

* Identify career goals, both short- and long-term. Do you want to develop advanced clinical skills, move into management, or focus on education or research? Make your goals specific-such as "be promoted within the year" or "obtain a position as an advanced practice nurse in oncology within three years"-to help direct your choices.

* Determine the knowledge and skills you bring to an organization and what you need from an organization in order to be satisfied at work.

* Identify your talents, such as art, music, complementary therapies, creative writing, fund-raising, or communications.

* List talents and skills you want to develop.

* Identify what you need from an employer to be successful. For example, would an internship, preceptorship, or mentoring relationship advance your goals?

* Define the type of position that interests you-for example, staff nurse, staff educator, or quality improvement staff-and the work settings you enjoy most, such as certain patient populations or specialty areas.

* What kind of environment matches your work preferences? Consider an organization's size, location, mission, and values.

* What benefits do you need? Adequate, affordable health insurance is essential, while access to a fitness center, though nice to have, may not be. If you have elderly parents or plan to start a family, family sick leave and maternity leave will be important to you.

WORKPLACE ASSESSMENT

Many employers offer bonuses and other incentives to fill vacancies, but there's more than salary and benefits to consider when choosing a workplace. Here are some suggestions for evaluating potential workplaces.

* Review organizations' Web sites and compare mission statements and philosophies with your vision of nursing practice.

* If possible, tour prospective units. Talk with nurses to find out what the place is really like. Are nurses accountable for coordinating patient care? Are there opportunities for direct-care nurses to participate in interdisciplinary committees? Do nurses have control over nursing practice through shared governance, clinical practice councils, or other professional practice models? Does the job description reflect these roles?

Some other important considerations include:

* opportunities for advancement

* staffing levels or nurse-patient ratios

* RN vacancy and turnover rates

* extent of temporary or per-diem staffing

* use of unlicensed personnel, including nursing assistants and unit clerks

* use and responsibilities of LPNs

* patient-satisfaction scores

* nursing education resources, including simulation labs to practice new procedures

* technologic innovation

If nurses are represented by collective bargaining, review the current contract. Determine if the union represents only nurses or if it also represents other workers. If the union represents other workers, look at its record of supporting nurses to be sure that nursing issues aren't overlooked.

It's important to determine the extent to which the potential employer has an organizational structure, policies, and actual practices that support nursing excellence. (See Hallmarks of Excellence, page 13.) Many of these hallmarks are often found in organizations that have achieved Magnet status. A Magnet facility is one that the American Nurses' Credentialing Center has found to satisfy specific criteria designed to measure the strength and quality of nursing, such as a culture of nursing excellence, a high level of job satisfaction, low staff nurse turnover rate, and appropriate grievance resolution processes.1 As of August 2007, there were 251 Magnet organizations in 44 states and one in Australia.2 Additionally, the American Association of Critical-Care Nurses grants a Beacon Award to critical care units that meet standards of excellence in seven categories, including patient outcomes, staff recruitment and retention, and organizational ethics. Look for Magnet or Beacon facilities as you search for new positions. Organizations that have maintained their status demonstrate a commitment to excellence.

Another source for assessing quality of care is the Centers for Medicare and Medicaid Services (CMS) Web sites for hospital, home health agency, and nursing home quality. The CMS publishes quarterly data comparing quality measures at all Medicare-certified agencies. (See http://www.cms.hhs.gov/homehealthqualityinits, http://www.cms.hhs.gov/hospitalqualityinits, and http://www.cms.hhs.gov/nursinghomequalityinits for more information.) These comparisons are limited in scope and should be used as only part of a comprehensive review of potential workplaces.

Choosing a new place to work and finding a position you love can be exciting, once your goals are clear. Career planning is much like the nursing process: assessment, diagnosis, goal setting, planning, implementing, and ongoing evaluation. Nurses today have many choices in employment. Make your choice the right one for you.

Hallmarks of Excellence

How to identify an organization that's devoted to top-quality nursing.

* The organization has a written philosophy of clinical care that emphasizes and supports evidence-based practice and focuses on quality, safety, interdisciplinary collaboration, continuity, and professional accountability, including an appropriate type and length of orientation for new employees based on their needs and competencies.

* The organization recognizes the effect of nurses' expertise on clinical outcomes. This includes aligning practice levels, roles, and responsibilities with education and certification.

* The employer hires and supports advanced practice nurses and other experts in permanent positions who are available for ongoing consultation and mentoring.

* Nurses hold decision-making positions, and the nursing department is directed by an RN in an executive position.

* Nurses participate in clinical decision making through shared governance, clinical practice councils, or other models.

* Clinical advancement programs are based on education, certification, and advanced preparation.

* Resources exist for professional development of nurses.

* Collaboration among providers is expected and encouraged.

* There is zero tolerance for abuse of nurses. Written policies and procedures are in place that demonstrate effective methods for reporting, addressing, and resolving abusive situations.

* The best technology is used in clinical care, documentation, and information systems.

* Clinically relevant quality-improvement initiatives guide clinical practice, operational decisions, and ethical choices regarding policies and practices that affect nursing.

* Wages are competitive.

* The environment exceeds regulatory safety standards.

American Association of Colleges of Nursing. Hallmarks of the professional nursing practice setting: what every nursing school graduate should consider when seeking employment. 2004. http://www.aacn.nche.edu/pnn/hallmarksbrochure.htm; Texas Nurses Association. TNA Nurse-Friendly(TM)hospital criteria: 12 essential elements for the ideal nursing practice environment. 2005. http://www.texasnurses.org/wkplaceadv/NF/nurse-friendly.htm.

Web Resources

American Association of Colleges of Nursing

Career development

http://www.aacn.nche.edu

DiscoverNursing

Information about specialty areas in nursing

http://www.discovernursing.com

Health Care Job Store

Recruiting site for searching for positions and posting resumes

http://www.healthcarejobstore.com

National Student Nurses' Association

Career development

http://www.nsna.org/career/planning_career.asp

NurseUniverse

Interview questions, skills checklist for nursing specialties, job listings by geographic region

http://www.nurseuniverse.com

Nursing Center Career Center

Searchable site to locate health care facilities by state and geographic region. Provides information on employees, benefits, and the surrounding community.

http://www.nursingcenter.com/careercenter/careerguide.asp

Nurse Credentialing

Site includes a manual describing characteristics of Magnet facilities.

http://www.nursecredentialing.org/magnet/forms/studentmanual.pdf

Sigma Theta Tau International Honor Society of Nursing

Career development, including placement and employment tips, resume writing and posting, and employment opportunities

http://www.nursingsociety.org/career

American Nurses Credentialing Center

Lists all Magnet facilities

http://www.nursecredentialing.org/ancc/magnet/getall.cfm

REFERENCES