Job woes in the SF Bay Area... why is it like this?

[NTPinky]

After finishing nursing school, it took me several months to finally get a job (I live in San Francisco and the market is tough here for new grads). Other RNs advised me to start anywhere, such as a clinic. I finally did get a position in a women's outpatient clinic (yay, income!), but I've always felt somewhat envious of my friends who started on the floor, because most RN attitudes that I encounter are that of "you have to start on the floor to be considered a 'real nurse'". I do a lot at the clinic, but other RNs seem to think that working in a clinic is not "real nursing." Even a couple co-workers who started on the floor have made comments.

Now we are facing layoffs due to budget problems, and I'm likely to get the axe in the next couple months because I'm per diem (though I work 5 days a week). I've been looking for another job but the problem is that even though I've been at the clinic for over a year, all the available RN jobs require the famous "minimum one year acute care experience," which I don't have. I had an interview at a hospital a few months ago (maternity unit), and was hopeful because they had six openings, and the Nurse mgr said my chances were good because they had so many openings. But I didn't get the job, and when I called to ask why or what suggestions they had for me to improve in future interviews, they told me they preferred to hire new grads.

So I don't qualify for new grad training programs because I'm not a new grad, but I don't have floor experience either. Is it only like this in the San Francisco Bay Area??? When I tell people I'm a nurse they often say "Oh good, you'll always have a job." And on a recent news report about the economy they reported that healthcare is one of the very few industries to not be affected by the national economic crisis, but I'm not feeling safe at all. And I have about $40,000 in student loans to pay off. I don't know what to do. Anyone else been in this situation?

I've looked into relocating, but I'm living rent-free here and salaries seem much lower in other areas, so I don't know if it'd be a good financial move.

[suzanne4, RN]

"But it is time to send all the nurses working here on VISA's back to their country to ensure our citizens keep working! "

I agree so much it hurts. We DON'T need foreign nurses anymore because it shows in the inability for domestic trained nurses to get jobs. All working visas should be revoked and the workers should be told their services are no longer needed. I know this is harsh but reality needs to step in and have these workers stop taking jobs away from American trained nurses.

Why is it that certain countries are training their nurses for the sole reason to come to the US? You will find very few US trained nurses wanting to go over seas. We need to make the entrance exams far tougher than they are now. Foreign trained nurses SHOULD be held to a higher level of competency, especially in the English level. So many of them fall so far short of English competency. OK, I have said my peice. let the naysayers come forth!

I have been against temporary work visas for a very long time, they do not help anyone, and most definitely not the nurse. Green cards and treaty visas are entirely something else. And if they are not available, then they are not avaiable.

Temporary work visas can be cancelled at any time by either the employer or the US federal government, and I do expect that we are going to see some cancelled in the near future.

And as things have been in CA for quite sometime, you do not see those with temporary work visas in hospitals here as the unions do not permit it. They only will accept the green card and treaty visas. And that is how it should be, especially since there are so many facilities that are trying to break the rules concerning the H1-B visas. These were designed for specialists, meaning one that has several years of experience in their field and not for new grads that have graduated overseas and have never worked since their graduation which could have been two years ago.

You do not want to cancel out all visas, what if one were to go to another country and fall in love with someone; you would want to be able to move to that country or have the other person be able to move here at sometime. So this needs to be taken into account as well.

There are some states that have been hit with companies employing many under the H1-B visas in nursing and this just does not help anyone and they were new grads as well. One that comes to the head of the list is Florida.

[suzanne4, RN]

Ratio laws are still in place in CA, they are state mandated and are not changing. The major issue that we are seeing is that the census is going down all over the state due to more people losing their jobs as well as health insurance.

For those of you that are out of state, it is maxium of two ICU patients to one nurse, four telemetry patients to one nurse, and maximum of five med-surg patients to one nurse. The ratios may look good, but one has to take into account that CNAs have been cut out of the picture in many facilities and total care is being done by the RN.

[suzanne4, RN]

Wow, quite a few responses since my last post!

The latest postings I've seen for LTC facilities were for LVNs. Seems they hire very few RNs and more LVNs because it's cheaper. I'll keep looking though, of course. I've seen new grad programs available in Southern CA lately, but they pay much less there (curious since the cost of living isn't much cheaper).

I get very conflicting opinions about selling myself as a new grad vs. not. I do a lot at the clinic, including managing gestational diabetic pts, triage, and even training more experienced RNs. And I don't understand the rationale behind hiring someone fresh out of school vs. someone like me.

As for ratios, I hear they get violated all the time. There is no such thing as break relief for inpatient RNs at my hospital, and the only one I know of in SF that for sure has break relief RNs is Kaiser. My friends who do inpatient at other hospitals are often asked to cover for another RN while he/she is at lunch. Isn't that technically breaking the ratio?

If I knew then what I know now, I think I'd have gone to medical school instead. Only reason I didn't is because I wasn't sure if I'd like the healthcare field and didn't want to end up in debt paying for something I didn't even enjoy. And here I am in a field I like but constantly worrying about job security.

And to top it off, I found out today that one of my high-risk pts and her baby died When it rains it pours!

There are many that have break relief nurses in the Bay Area, have been in the area for close to three years and have had a break relief at each facility.

And the nurse that covers cannot have their own patients at the same time or then they are over the ratio, and the facility has to pay additional penalty pay to the RN. This can be very costly for them. The facility has a choice as to who will cover the breaks, it can be the manager or the charge nurse as long as they have the skills for that patient set; if a facility is not doing this and they are unionized, then it is something that the union needs to be notified about as it is specifically written into the contract and the facility is held accountable for it.

---------------------

Now back to your questions:

This is just the way that facilities handle things. You are considered to have been away from the bedside since you have graduated from school. You are seeing patients just for their clinic appt, and not continuous for the entire shift.

Even though you may see jobs posted in the SoCal area, be aware that HR is required to post the jobs, but many will not be available as they managers already know who they wish to hire by students that rotated thru or did externships there. We are seeing more and more of this as well as several of the new grad orientations that had hired the new grads have been cancelled out in the past few weeks just before beginning and all of those new grads are trying to get hired as we speak.

Bay Area is one of the highest paying in the country, that is why many others wish to move to the area as well. Generally speaking, the apartment rents are significantly higher than they are in the LA area. Costs of everything else is also higher in most cases too. You will see a significant difference in pay between the two locales.

But things are bad in the LA area as well. If one has at least two years of experience as an RN, then things are not as bad. Less than that and it is going to be much more difficult.

You may wish to consider a rehab type facility vs. a regular hospital as well. That may give you more options and they do have quite a few RNs since the patients require more care.

[Neveranurseagain, RN]

Quoted by Suzanne:

So, as you would put it, then any American working in any other country that has permission to work there needs to be sent back to the US as well? Things do not work that way. Sorry.

Would appreciate it if you stick to what is being discussed here and on-topic.

Suzanne, I just had to respond to this statement. If that country has citizens who are capable of holding the jobs that Americans are doing overseas--then Yes! Send those Americans home and put their own citizens to work! Same as we need to do here--if we have citizens capable of holding jobs that foreign nurses have, then send home the nurses working on visa's. Ok! I'll stay on topic now! :bowingpur

[pizzagirlRN]

i am so sorry to hear about your high-risk patient and her baby dying, this is very sad news. i am sending blessings and big hugs to you :redpinkhe.

[NTPinky]

Interesting turn of events today...

The medical director of the clinic today asked me to let her know asap if I get another job. I told her my situation and that I wasn't planning to leave. She said, "Good, because we're going to need you a lot more." (Because they're reassigning 5 RNs to inpatient units, but they can keep per diems like me for now.)

And then I got a voicemail at home from a nurse mgr from a diabetes center at another major hospital in SF. It's a position I had applied for weeks ago, and I thought it was a long shot since I don't have the 2 yrs of acute experience listed in the job ad. I'll call her tomorrow! I'm just nervous that, as Suzanne said in one of her replies, that this hospital will cut staffing due to decreased census thanks to the economic crisis.

I'll keep you all posted. And thanks for the support and information.

[suzanne4, RN]

I would most definitely stay where you are for now. At least you have seniority there. If you move to another facility, then you are going to be the low man on the totem pole and subject to being the first laid off.

Remember that clinic staffing can be cut, they cannot make cuts that will affect the patient ratios at the bedside.

[NTPinky]

Hi Suzanne,

Right now I have some seniority, but only over other per diems, and they can let me go whenever they want, though for the next couple of months I'm probably safe. The hospital administration's end goal; however, is to keep just one RN in each outpatient clinic. They have already announced plans to make another round of drastic cuts in June, and I'm probably going to be hit in that round.

[pennyg1]

Hi there,

I've been a nurse at a major bay area hospital off and on (more on) since 1988. 1 year ago I took a year off to look into going back to school for an MSN and decided not to do that. So I thought, I'll just go back. Wow, was I ever surprised. It took me 5 1/2 months of very active looking and contacting EVERYONE I know but I finally got a job. Not back in the hospital but close by.

Here's what I learned in the process: There is not a shortage of nurses in the Bay Area. A lot of nurses who were planing on retiring didn't and part time/per diem nurses picked up more hours and as a result there are few to no positions left. When you see a position posted it's because the hospital is legally required to post any open reqs for a certain period of time but most of these positions are filled by internal candidates.

A few suggestions as a new grad: 1. Cast a wide net 2. Volunteer in a health related area (ie. American Heart Association)

3. After filling out the online applications, call the recruiting office and get in front of someone and start talking. 4. Drop off a resume and cover letter to the mailbox outside the door of the manager who will have the final say on who gets hired.

Good luck!

[kim129]

I am a new grad. But I can't find any open positions for someone like me. If no hospital wants new grad, how can we start? If I start with clinic or nursing home, I guess I will never get a job in the hospital again. It's not even easy to get a job in the nursing home. Some nursing homes need experience too... ...desperate new grad!!

[kim129]

If you have a choice, go to another state or some. I am from Oklahoma. For what I know most of my classmates have already got a job there. I just had to move here with my husband cuz he got a job here.

[shah]

You need to get out of your area. Think Compact states. Here in Texas, they are hiring in San Antonio, San Angelo, Brownsville and other places where people don't want to work. The pay will not be like CA, but you could rent a 2 bedroom apt. for $500, and get some experience.

One good option is LTAC Rehabs. They will give you good experience, but not be as choosy as Acute care and the patients are not as sick as hard core LTAC. Nursing homes will also be very receptive.

One good piece of advice: Hospital nurses are snooty at best. Do not care about another person's opinion. The ones who look down at non-hospital experience are merely ignorant. There is need for good nurses in clinics, nursing homes, home health and a myriad of other places. The burnout rates are low, it is more personal and a more benign work place. If you stay out of the hospitals, you may last it out longer. Hospital nurses may be snooty, but they are harried, angry, and mean. They eat their young on a regular basis.

Personally, I hope the best nurses end up in nursing homes, as those are the places where we will all end up eventually (including hospital nurses).