Landing a New Grad Job on a Specialty Unit
Hi friends! Hope you've all been well. I'm just about 6 weeks into my new grad residency program and if you've been following along on my Instagram, you all know that I've been learning so incredibly much. My two preceptors are amazing and empower me to be the best L&D nurse that I can be. If you want to know how I passed NCLEX in 75 questions, you can read about it here.
If you're new here, I'm a new grad RN, (hi!!) and I'm working on my dream unit! We deliver the most babies in the nation and the world (!!!). This specific unit was my goal when I started nursing school, because I knew that by starting off on a busy unit, I would see a variety of cases and I would be challenged to think critically and be on my toes. Labor & Delivery was always my #1, though I did absolutely love ICU, especially the palliative care portion of it. So today, I want to give you some pointers into getting that dream job and sharing what I did to secure my spot in this nurse residency program.
Now, before I go on: Keep in mind that I live in Atlanta and there are many large hospitals in my area, with a surplus of new grad residency programs. (Click here for my explanation of a nurse residency program.) This means that there were many units hiring new grads, including many specialty/high acuity units, such as CVICU, MICU, PICU, Peds ER, L&D, Oncology, Peds Neuro, etc. However, there were about 120 people from my cohort alone, and multiple other nursing schools in my area, so although there were lots of residency spots open, there were also a lot of us new grads.
Before OB Rotations
Because I knew that I wanted to pursue L&D from the get go, I kept feeding my passion. And this was a bit difficult because my OB course in nursing school wasn't until the 2nd year. But this meant that I was doing personal research on current national and global healthcare issues, such as the devastatingly high maternal mortality rates in the US. I also followed other nurses/NPs/medical professionals working in women's health, such as Monica from @givememoremonica on Instagram, who is a Family Nurse Practitioner who specialized in Women's Health, and Natalie from @nataliecrawfordmd who is an infertility physician in Austin, TX. And this is when I say, "Representation. Matters." Because through them, I was able to see what it was like to pursue a career in women's health. Because without their presence on social media and their knowledge and wisdom they chose to share, dreamers like me could learn outside of school. And just because I wasn't currently in an OB course or clinicals, that didn't mean that I had to stop learning.
Before I even had my OB clinicals, I made sure to take advantage of every observation opportunity I could get. My clinical instructor herself was a L&D nurse for 25 years on that same exact unit, and I am still so grateful for her friendship and mentorship. She knew my passion for women's health, so she advocated for me when we had observation opportunities. I made sure to be able to see everything I could - the ICU, cardiac cath lab, dialysis, rapid response, etc - but I wanted to go to L&D every chance I could.
Securing an Externship
With those observations opportunities I was able to get, I saw my very first vaginal delivery in the first semester of nursing school while we were on our Med Surg rotation. I also was able to see my first c-section and it was so incredibly cool in the moment, though now I think I've probably seen more than a hundred! Those observation opportunities gave me insight into what the roles of an L&D nurse were, and I was immediately drawn by the fact that L&D nurses wear so many hats and are able to see so much - anywhere from a typical vaginal delivery to stat c-sections that lead to D&C, hysterectomies, massive blood transfusions, etc, or preeclampic seizures, neonatal resuscitation, triplet deliveries, you name it. So I wanted to get my foot in the door and work in the hospital as an extern so that I could have a higher chance of getting hired on, as most hospitals prefer hiring their own employees for open positions.
I applied for the L&D externship between my junior and senior year of nursing school and with 2 of my friends, interviewed for the job. None of us got it and we were so bummed, as we were sent off to interview with Postpartum/Family Centered Care instead. The 3 of us all worked that summer and then for the rest of nursing school as techs on postpartum and we are all grateful for the experience we got from it. Now, we're nurses in the ER, peds OR, and L&D!
I learned so much about what happens after labor and delivery, how a woman's uterus needs to sufficiently firm up to prevent bleeding, how to take newborn baby vital signs, how to aid a physician during newborn circumcisions, which medications a newborn receives upon his/her first 24 hours, what a PDA looks like on a newborn, etc. It was an amazing way to spend that summer where I could have been doing nothing, because 1. I got paid as a tech, and 2. I was able to learn so much about working in a hospital, working 12hour shifts, working with other members of the healthcare team, prioritizing, communicating with nurses and physicians, and interacting with patients.
I tell all of you who ask about my experience as a tech that I will always remember how important teamwork is. I know that I am a better nurse because of my experience as a tech. Not only because of the patient contact experience, but also because I was able to gain so much insight as to what goes on in the hospital setting and how my actions can have an impact on a patient's care and life. Though postpartum isn't L&D, it helped me get my foot in the door of women's health and I use so much of what I learned that year today as an RN.
My OB Course + Rotations
As senior year rolled around, I was so stressed. The classes were hard but I also had to get more serious about prospective jobs and NCLEX. But even with the stress, I was so pumped for my OB course and clinical rotations. Little did I know though, I would definitely doubt my place in L&D because the material was seriously no joke. Women's Health is a completely new world compared to medsurg and it's an entirely different language. The vital signs and labs are all different in pregnant women, postpartum women, and newborns, so it's hard to discern what is normal and abnormal. I definitely struggled in that class and had to study harder that I've ever had to, which caused an internal dillemma - Is this what I'm really meant to do if I'm not good at it?
I was proven wrong during my rotations, though. Because I did great with those laboring patients and new moms, if I do say so myself. This is when it all made sense - I could struggle in a course but that doesn't mean that I'm necessarily a bad nurse. My test scores do not dictate how I will care for a patient. I loved my OB rotation, though it was way shorter than it should've been (I did 2 days of L&D, 1 day of postpartum because I was already an employee on the unit, 1 day in NICU, and 1 day with the admission nursery team). I was thriving and knew I had to work hard to secure a practicum placement on the L&D unit to increase my chances of getting hired on the unit.
Before I had my OB clinical at the same hospital, I asked to be placed there for my senior practicum. But because this unit is highly desired and most available practicum placements were general medicine units, I knew it would be difficult to be placed on my dream unit. That's why my top three were as follows:
1. Labor & Delivery
3. Admission Nursery
My reasoning was this: I love babies, but I knew I didn't want to work in postpartum as a new grad, so NICU was a great specialty where I could learn a ton and be challenged while still working with babies. I also asked for admission nursery (the team that comes around to all the deliveries to admit and assess newborns), but in hindsight, I'm so glad that I didn't do that as the patient population (newborns) and the work (assessing and bathing newborns, administering the same 2 meds) isn't the most challenging for a new grad nurse.
I got my practicum in that same unit, and I worked with several different preceptors, but I had 2 main ones who are now my coworkers! This is when I officially got a taste of what it's like to be a labor & delivery nurse. One of my preceptors, Candace, is now my preceptor for residency and I love her. It's crazy to think that she has seen my progress from a nursing student to a new nurse and I've learned so much from her. During this practicum experience, I was able to do so much - attempt IV starts, insert foley catheters, read fetal strips, administer medications, recover post c-section moms, assess newborns, circulate in the OR, do sterile vaginal exams, coach women during labor, teach moms how to breastfeed, etc.
During my time on this unit, I did 12 hour shifts to fulfill my 164 hours and I made sure to be my very best. After all, if you really think about it, this period of time is kind of like a mini job interview! I made sure to make myself as useful as I could and be a positive student who was always willing to help. My clinical instructor also made sure to put in a good word for me with one of the clinicians who is in charge of the new grad residencies, as did my preceptors. I'm so grateful for their help and advocacy because without their support, I would not be where I am today.
Applying + Interviewing for Jobs
When it came time to applying for residency programs, I applied to this hospital and also 1 more. I received a phone interview with the other hospital but was never contacted for a 2nd interview because they had filled up that spot. In retrospect, I should have called her rather than emailing her because I had waited for an email reply for about 2 weeks. Fortunately though, I was able to interview with this hospital I'm with right now and get the job! If you need tips for interviewing, check out this post that Caleb and I wrote after we accepted our new jobs.
During the interview, it was very helpful to have had my postpartum extern experience, as well as my OB clinical experience, and practicum experience, because I was able to use the proper terms and elaborate upon the questions they asked using real life scenarios. I also believe that I was a good candidate because my resume and experience showed that I stayed passionate to this specific realm of nursing, with my past work experience in women's health, rather than seeming like I randomly drew this specialty out of a hat. The clinician who I'd met during my first year of nursing school remembered me by name because she had heard it repeated so many times by my clinical instructor and my preceptors (and my emails), and now among 24 residents, she knows me by name.
Put yourself out there. Be annoying. Make them remember your name. Keep emailing people. Stay positive. Advocate for yourself and your dreams. Work so damn hard. Stay focused and keep doing those relevant things. Don't worry so much about "doing too much." Be extra and do the extra work. It's worth it.
Landing a new grad position on a specialty unit can seem difficult and often times impossible. However, much like anything else, with dedication and will, it's possible. So don't "settle" for that 1 year of medsurg that older nurses love to talk about. (Though it never, ever hurts.) If your dream is to specialize, get into the specialty you've dreamt about and devote yourself to learning all you can about it.