As stared in my previous post, I'm moving. I got offered a position in the ICU in Texas I live right outside of NY City. Even in Texas, things are competitive, even for the natives. I suggest not only cold calling but visiting the hospitals, SNFs, doctor's offices. Let them see you in person. Especially if you live out of state. That shows committment. But, even if you can't move out of state, don't simply sit home and fill out applications online..pound the pavement.
I believe if you want something bad enough, you'll go after it relentlessly.