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Step 1

You've Passed the NCLEX.
Now what?

Finding Your First Job as a Registered Nurse

Congratulations! You’ve not only come out on the other side of a rigorous and difficult education, but you’re now officially a Registered Nurse and are ready to start what can become an extremely fulfilling and high-growth career!

Now that you can finally get rid of those NCLEX books, notecards, study guides, and apps, it’s time to focus on applying all the knowledge and experience you have to start practicing with those new initials after your name.

While starting a nursing career is a really exciting time, it can also be a bit daunting to find new opportunities as a new grad. So, we’re here to help navigate this time to get you started off on the right foot.

In this section, we’ll cover what you need to know from a high level in order to get a handle on what comes next and what you can expect. In the steps below, we’ll go into more detail so you finish this series with an action plan to make sure you’re set up to succeed in your new career as a Registered Nurse.

three nurses looking at x-ray new grad residency program nursing school


Specialty

Whether you know exactly which specialty you’d like to pursue, or you haven’t the slightest idea or preference, there’s a lot to consider.

If you did a capstone on a specific unit, that experience is valuable in two ways: first, you probably have a pretty good understanding of whether it’s one you’d like to pursue; and second, the experience, though probably brief, can help you land a nursing job in that specialty (but also potentially be turned down for others).

Some specialties are more opportunistic for new grads than others, so it’s important to be ambitious but also open and flexible. For example, as you may have heard by now, it’s relatively easier to start in acute care, specifically Med-Surg (more on this later). It’s most important to get initial experience in an environment that provides for learning, growth, and support with getting through the steep learning curve of being a new grad nurse. 

Keep in mind that it’s not the end of the world if you don’t start out in the specialty you’re most interested in. Your first nursing specialty can be just that- your first. On the other hand, it may actually positively change the trajectory of your career in ways you didn’t anticipate.

Consider getting certified in that specialty or getting additional certifications that might make you more marketable. For example, if you’re set on working in critical care, take steps to getting ACLS certified. 

For pediatrics, PALS is now required nearly everywhere, and seeing it on your resume can be the differentiator between you and another applicant with a similar profile. While it’s not always required in order to apply for the position, it shows initiative and dedication. 

Something to keep in mind from a strategic standpoint is that it’s typically easier down the line to switch specialties in certain situations. For example, it’s easier to switch specialties within pediatrics, or within critical care or acute care, rather than from one to another. It doesn’t mean it’s impossible, it just tends to be a bit easier from an opportunistic standpoint.

Care Setting/Environment

The beauty of nursing is that there are a variety of care settings to work in, whether it’s acute care, primary care, critical care, or ambulatory care (just to name a few!). Deciding which care setting is right for you should take into account your strengths and motivation. Think about the types of environments you regularly thrive in throughout various aspects of your life. Consider the following descriptors and what resonates with you - fast paced, high intensity, focused, detailed, autonomous, team based, more hands-on versus not.

Care setting is typically a function of specialty. Keep in mind that, generally, starting with inpatient care will make it easier to navigate through different opportunities later on. It can be difficult to move into inpatient later on without prior experience, and when you’re no longer a new grad. Nurses tend to learn a lot of hard and soft skills from inpatient experience that transition more seamlessly to outpatient care than the other way around. But again, that’s not to say it’s impossible!

Getting Started - That First Job

Some hospitals and health care facilities will hire new grads, whereas others require you to be hired specifically through a new grad program, also known as a nurse residency program. These are typically only offered during certain times of the year or on a periodic basis. 

Alternatively, there are health care facilities or employers that will train you on the job and don’t offer or require a formal program. 

The route you go will depend on your preference, but also on the opportunities available based on your specific (or non-specific) preferences.

Finding Residency Programs

A Nurse Residency Program is a formalized entry into nursing practice that consists of both structured hands-on and classroom-based learning on clinical and professional topics. Residency programs are usually created and hosted by hospital systems and can last from three months to one year in length.

Most hospitals will advertise their programs on hospital career pages. It’s not uncommon for there to be a lack of information about specifics: when applications open, when the assignment starts, application and eligibility requirements, etc. Some don’t specifically call out that it’s an RN residency program and instead just post positions for Clinical Nurse I’s, RN’s, etc. It requires a decent amount of diligence to become informed of these. 

If you’re flexible on where you go but know you want to start in a residency program:

  • Determine which hospitals have recurring residency programs
  • Set Google job alerts on the facility career pages so you’re alerted as soon as they open
  • Input application dates on your calendar
  • Reach out

If you’re pretty set on working at one or a select few hospitals:

  • Locate their career pages and bookmark them
  • Study up on the hospital’s mission, vision, values, and ensure your application reflects alignment
  • Convey your excitement and interest by writing a compelling personalized cover letter for these few hospitals you’re really interested in; ensure it’s not cookie-cutter and seems like something you’ve simply attached to every application you’ve submitted
  • Be diligent about searching on these pages and within open positions for any mention or information about a new grad program
  • Connect with a clinical educator that runs the program
  • Reach out to a hiring manager
  • Reach out to a nurse that may work on that unit or has gone through the program before to learn about their experience
  • Utilize your network - nursing school, friends, family, etc.


Alternative Initial Jobs for RNs

Think outside the box. It can take some time for a new grad program to open up, and the sooner you can get experience, the better. Look for non-traditional opportunities that may be easier to start in without prior experience. These may be flu shot clinics, school nursing, occupational health, home health, or primary care. 

If you start in one of these settings but know that you still want to pursue inpatient care or a different setting, be sure to not let the fact that you’re now working with an income and experience take your eyes off the prize. You must remain just as motivated and persistent about the job you really want as if you were unemployed and didn’t have an option B.

Utilize your network. It’s often not obvious which health care facilities will hire nurses without previous experience but don’t do a formal new grad program. Consider starting where you did your capstone or geographically close to where you went to nursing school. 

While new grad programs are comprehensive and have proven positive outcomes, it doesn’t mean that you can’t receive a lot of the same benefits and professional exposure elsewhere.

Advice & What To Do Next

Take initiative and get exposure:

  • Shadow when and where you can
  • Connect to those in your network and reach out to learn more; the ask doesn’t necessarily have to require a lot from someone else (avoid any variation of "Hey, can you get me a job?"), but rather try to learn from their own experience and what advice they might have for you having been in your shoes before


Get your ducks in a row:

  • Letters of Recommendation
  • Don’t wait until you need them to ask for them!
  • Provide as much detail to your references as possible; give them ammunition to write a glowing recommendation
  • Give them specifics about the hospitals you’re most interested in working at so they can tailor the letters
  • Ensure you get both general and specific letters of recommendation

Be selective about how you use the time you have now. Once you officially enter the workforce, you’re likely going to be gainfully employed for a long time. While it may seem urgent and important to get that first opportunity and start working, it’s worth keeping in mind that this is precious time you’ll likely never get back. If there is anything on your personal bucket list that you anticipate making logistically work down the line when you are in a committed full-time position, consider how you can do it now.

Certain experiences often make you more interesting and marketable. A good opportunity is to plan something for the time immediately after you take your NCLEX. If you’re properly preparing and sit for the exam in a short while after graduation, you’ll want and need a period of time focused on your health, wellness, relationships, and personal goals. This will also help to take your mind off of the wait until you receive the results and are officially licensed!

In the following articles, we'll go into more detail of each of the topics we touched on here.

Next Step →
Sarah Gray, RN
Sarah is a Pediatric Clinical Nurse III at UCSF Benioff Children's Hospital and a UCSF 2017 Evidence Based Practice Fellow. A New Jersey native, Sarah graduated from Penn Nursing and has been living in San Francisco ever since. She's been an athlete her whole life and continues to be passionate about health, fitness, and making the most of all opportunities. She continues to harness her passion for innovation and process improvement in her role as Founding Clinician at Trusted Health.

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