Preparing Your “Script”

Become a good sales representative for yourself by anticipating probable and possible questions that might be asked during your interviews. Later on we’ll focus on technical questions, but before any technique questions come your way, the nurse recruiter and the nurse manager need to get to know you by asking some probing questions. No one knows the questions that will be asked – sometimes the interviewer comes up with the question on the spot. However, you can anticipate typical questions asked in interviews and anticipate questions that your background might generate, such as gaps in employment or short periods of employment.

Prepare a response to each anticipated question similar to how politicians prepare for questions posed by the media or are asked at public events. Prepared responses (talking points) are commonly referred to as a script. The script is carefully written with words and phrases that convey a response that will satisfy the audience’s curiosity. Politicians memorize the script and “stay on script” (recite the script) and avoid “going off script” (ad-libbing) when answering questions. You should do the same so you won’t be flustered and appear confused at the time of the interview. Instead you’ll come off appearing confident and honest. The script should be a few short sentences that clearly answer the question. The goal is to deliver a succinct response.

Here are some likely questions that you’ll be asked. Write a script for each one.

Make a list of questions based on the job requirements listed in the job posting. The nurse recruiter will probably walk you through each job requirement to determine which requirements you meet. You should have a script prepared for each requirement that clearly links your background to the requirement. Be forthright if you don’t meet the requirement. Your script should acknowledge that you’re lacking the requirement, however, show how something in your background is similar to the requirement or how you plan to meet it in the near future. For example, “I’m not ACLS certified; however, I’m scheduled to take the ACLS course in four weeks.” But if you don’t meet a particular requirement – and will not in the future – say so. The nurse recruiter will decide if that’s a deal breaker or not.

Here are some basic considerations that you should be prepared to address (see Bring a List of Questions to Ask, later in this Chapter):

Create an opening “script” for the initial meeting with the nurse recruiter that includes the greeting and small talk such as “this was an easy place to find” or about the current weather – something to set the stage for the interview. Keep everything upbeat. Speak with confidence. Be yourself. The worst that can happen is you’re not invited back to the next interview, but you might be surprised.

Scripts have stage direction that tell you what you should be doing. Some nurses include stage direction in their interview “script.” Active listening is the stage direction found in many “scripts.” You stop, listen, and process what the interviewer is saying to you. This is the most important action you can take during an interview. You learn by listening, a nursing instructor once said.

Remember that the nurse recruiter leads the interview – not you. The nurse recruiter can take any number of directions once the small talk is over. Some nurse recruiters begin with an open-ended question such as “tell me about yourself.” Others may step through your resume quizzing your experience such as, “I see you are a med-surg nurse at ABC Medical Center. Tell me about what you do.”

Be prepared to follow the nurse recruiter in any direction that he or she takes during the interview. Anticipate questions similar to those mentioned in this chapter and then prepare a “script” to respond to each question. “Scripts” help you speak with confidence on anything about your background and nursing. You’ll come across as a professional especially when the nurse recruiter compares you to other candidates who apply for the same position.

The Game Plan

You know that you can do the job successfully but you still must make it through the pre-employment gauntlet before you’ll get a chance to prove your clinical skills to the nurse manager. This can be a frustrating period but you must put aside those frustrations and perform every task requested of you as if each task is an exciting new challenge. Leave the “attitude” at the doorstep especially if you feel that your experience and training should exempt you from some pre-employment activities (for example, testing). You are being carefully observed during all phases of pre-employment (as well as during the probation period if you are offered the job). Typically, the nurse recruiter and the nurse manager will stop the pre-employment process if the candidate appears to have an “attitude.” They would rather cut their losses sooner than be saddled with a problem employee for the long haul.

There can exist situations that you prefer the nurse recruiter to gloss over rather than explore in detail. For example, you might have had a position that didn’t work as well as you had hoped and it clearly appears on your resume. Expect that the nurse recruiter will bring this up during the interview; however, your response determines how much time is spent exploring the situation. Here’s a strategy that may help you deal with uncomfortable situations in your background.

It’s a Wrap

Plan your conclusion as the interview winds down by preparing a “script” for your closing act. Leave on a positive note and imply that you want to remain a candidate for the position, even if you don’t want that position. You don’t want to bring closure to your candidacy during the interviewing process. Wait until they offer you the position before telling the nurse recruiter that you are no longer interested in the position.

Rarely will you be offered the position on the spot, although that might happen if the hiring nurse manager conducts the interview. Be cautious if you get such an offer. Have a “script” prepared that politely probes why the offer is being made on the spot (“I wasn’t expecting such a quick decision”). This opens the door for the nurse manager to explain the situation. You might have been the last candidate interviewed and you surpassed the qualifications of the other candidates. On the other hand, it might also be that not many other candidates applied for the position – you’re the first one who wanted the position since the job was posted months ago and they’re desperate to hire someone. This may not be a good sign for you. Why didn’t others apply for the position? Did they know something you didn’t about the nurse manager, the unit, or the healthcare facility that would make the position undesirable?

Even if you’re “hired on the spot,” it is not official. The nurse manager needs to process the hiring decision with the nurse recruiter. Typically, the nurse recruiter formally reviews the job requirements and compensation with you. You must verbally agree before the nurse recruiter sends you the official offer letter in writing. The offer letter states the terms of employment and supersedes all verbal and written communication about the job. Any arrangements you made with the nurse manager that are not contained in the terms of employment might not be enforceable. For example, if the nurse manager agreed to give you every Wednesday off and this is not stated in the offer letter, then you may not be getting every Wednesday off and should address this before formal acceptance of the offer.

Interviews tend to end either because you’re not a fit for the position, or you are no longer a viable candidate compared with other candidates. The nurse recruiter is usually straightforward and will tell you if you are no longer a viable candidate. Don’t take the rejection personally. The nurse recruiter knows the culture and personalities on the unit plus performance expectations and feels that you won’t be successful in the position. Prepare a “script” on how you are going to respond to the rejection (“I appreciate that you’re being upfront. Are there other open positions that might be a better fit?”).

You might be asked to meet with the hiring nurse manager if you’re still in the running for the position. Be accommodating. Try to meet with the nurse manager immediately following your interview with the nurse recruiter if offered. You’re already warmed up for the interview with the nurse manager – and you don’t have to come back. You finish the interviews in one day. If the nurse manager is unavailable, then schedule an interview as soon as possible.

Don’t become overly optimistic. A good nurse recruiter always gives candidates the feeling that everything is on track for a job offer, though it might not be necessarily true. The nurse recruiter usually hedge bets if the top candidate turns down the job. Prepare a “script” that you can use if you’re still a viable candidate (“Thank you for the opportunity to explore the position. I’d like to continue our discussions. Do you have any timeframe when I might hear from you?”).

Some Thorny Questions

There are questions that in the United States are illegal to ask during a pre-employment interview, and some questions that might be asked are simply inappropriate. The nurse recruiter probably knows what questions cannot be asked during the interview; however, some nurse managers may be inexperienced at interviewing potential employees and may deviate into illegal or inappropriate questions during the interview.

Areas off limits to pre-employment questions are:

Be aware that the interviewer may intentionally or inadvertently touch upon these areas indirectly during the conversation. Rarely will you be asked questions directly. For example, “We live in the same town. My daughter is a junior at the high school.” This may lead you to continue the conversation that reveals “do not ask” information such as “My daughter is in the first grade.” This reveals your family status. Although your response may seem inconsequential, the interviewer may extrapolate situations that may interfere with your employment – a young child at home raises childcare issues during working hours.

The nurse recruiter and experienced nurse managers may use carefully worded questions to explore “do not ask” information but are perfectly legal because the question focuses on whether or not you are able to perform the job function. For example, you might be asked if you can lift 50 pounds or stand for six hours per shift rather than “Do you have any disabilities that prevent you from working?” You can be asked if you can work overtime or if you are willing to travel, but you can’t be asked questions about family status that may interfere with your job.

The interviewer can’t ask you your age or cunningly asking the year you graduated from high school to estimate you age. You can be asked if you are over the age of 18, which is the legal age to work in most states. Likewise, you can’t be asked if you are a U.S. citizen but you can be asked if you are authorized to work in the United States.

If you are asked directly or indirectly a “do not ask” question, then politely ask for clarification (“I’m a little puzzled by your question. Can you clarify it for me?”). Hopefully the interviewer picks up your hint that the “do not ask” line is about to be crossed. If not, then you can restate the question in a way that focuses on whether or not you can perform the job (“I’m not sure I understand the question, but if you’re asking if I’m available to work overtime, I am as long as it is not every day.”)

Some questions may probe how you would respond to a realistic situation where there is no easy answer. Simply think through the question and respond reasonably. Don’t try to give an answer that you think the interviewer wants to hear. Here are a few of those questions.

The practitioner gave you a direct verbal order to obtain a written pre-procedure consent from the patient. Hospital policy requires the practitioner to obtain the signed consent directly from the patient. What would you do?

Two of your most difficult patients ring the call bell at the same time. You are the only staff member available on the floor. What would you do?

You and your colleague are at the nurse’s station. A family member approaches your colleague stating that it is time to give her daughter pain medication. Your colleague is the daughter’s primary nurse and tells the family member, “I’ll be with you in a few minutes.” The family member turns to you and tells you that it is time to give her daughter pain medication. What would you do?

Bring a List of Questions to Ask

You need to decide if the job is a fit for you and the best way to make your assessment is by gathering information that might influence your decision. Listing factors that you are looking for in a job is a good way to begin your assessment. Focus on the obvious — and the not so obvious – ways that they will affect your quality of life both at work and during off-hours.

Write a “script” using wording that doesn’t imply the importance of the question to you accepting the position. For example, instead of asking “Is there adequate parking on campus for employees during all shifts?” you may want to rephrase the question as “How is the parking situation for employees?”

The nurse recruiter is likely to be forthright in responding to the question. Always respond positively even if the nurse recruiter’s response is a possible deal breaker for you. Perhaps the nurse recruiter tells you that employees park in remote parking areas off-campus and are bussed to the campus and that employees are responsible for clocking-in on time. This could end up being a quality of life issue for you since your arrival time must consider the extra time to go to the remote parking area and the shuttle bus schedule during change of shift. The same consideration must be given at the end of shift. You may not want this hassle, but don’t give the nurse recruiter any hint that this is a problem at this time. Make a list of pros and cons about the job if you are invited back for another round of interviews or are offered the position and then decide if any showstoppers are truly showstoppers. You’ll be in a better mindset to make this decision than during the interview when the potential showstopper appears.

Here are a few questions that you may want to consider:

If the Interview Doesn’t Go Well

Be prepared if something does not go well during the interview. Something you said might be taken the wrong way, or there may be a misunderstanding about what the nurse recruiter is saying. Whatever the case, the temperature of the interview changes from warm and cozy to chilly. You’ll notice this right away when the upbeat tone switches to uncertainty — focusing on mismatches to job requirements rather than matches.

You may not experience this; however, prepare for this possibility. A good strategy is to acknowledge the concern immediately when you detect the change in direction (“It seems that you have some concerns”). The nurse recruiter will likely appreciate your observation because there is an issue that the nurse recruiter needs to resolve and you’ll be able to get the interview back on course.

Plan to ask the nurse recruiter to tell you about her concerns. Listen carefully to the response. The nurse recruiter’s response may indicate that your original choice of words might have been misleading or words used by the nurse recruiter may have misled you. Clarify the issue using different words. Better yet, plan to describe a scenario that illustrates the situation in conflict and how you would handle that situation.

There might be deal breakers for you or the nurse recruiter that make it impossible to continue the pre-employment process. You’ll probably know where your qualifications are weak when you compare your background to the job requirements. These weaknesses might have been noticed for the first time by the nurse recruiter during the interview, which dampens the upbeat tone of the interview. Write “scripts” to address each potential issue. Don’t hide the mismatch. Explain your plan to meet those requirements shortly after being hired, or why your other qualifications weigh more than your deficient. Write another “script” that you can use if this truly turns into a showstopper. Thank the nurse recruiter for taking the time to chat with you about the position and ask if you would be considered for future positions in the healthcare facility.

Be Prepared to Walk Away

Prepare to negotiate. The initial interview with the nurse recruiter is probably not the time to enter into negotiations unless you are offered the position on-the-spot. However, you should do your homework to prepare to negotiate if and when that time comes. Senior management negotiates a contract that has a start and end date and contains specific expectations of both the healthcare facility and the senior manager. Employment terminates at the end of the contract period. Both sides need to sign a new contract to continue employment.

Most employees are not senior level and will not be offered a contract. In place of a contract, you receive an offer of employment letter that states terms of employment. The letter contains your title, where you are going to work (for example, float pool, unit), shift, wages, and when to report to work. Terms of employment generally reflect the healthcare facility’s contract with the bargaining unit, if your position is covered by the bargaining unit. You still abide by the bargaining unit contract even if you decide not to join the union (if permitted by law) as long as your position is a bargaining unit position.

You and the nurse recruiter may have some discretion to modify the standard terms of employment. Depending on your position and the healthcare facility’s policies, this discretion may not exist or is very narrow. Assume that it exists and prepare to negotiate terms of employment at the appropriate time during the pre-employment process. You might be surprised that a barrier to employment for you isn’t one for the nurse recruiter who can remove that barrier.

Decide the minimum terms of employment that you will accept and list them before meeting with the nurse recruiter. Also create a list of ideal terms of employment: the perfect job. For example, you have off every weekend in the perfect world; however you are willing to work every Sunday if you have off every Saturday because you have another job on Saturday that you need to keep. No weekends would be an ideal term. No Saturdays is a minimum term.

Minimum terms of employment are the “line in the sand” that you won’t cross. This is your “walking away” point. The nurse recruiter also has minimum terms of employment or a “line in the sand” that won’t be crossed — their “walking away” point. Don’t waver on your minimum terms of employment and feel that you’ll figure out something when the conflict occurs. The pre-employment period is where you identify and resolve conflicts, not after you begin work.

Ask the nurse recruiter toward the end of the initial interview to walk you through details of the pre-employment period, orientation, probation period, and remaining of the work year. Take good notes and refer to your notes when developing your minimum terms of employment and ideal terms of employment. For example, you might be expected to work the day shift during your orientation then change to the nightshift, which is your regular shift. This might conflict if you already have a day job and want this new job to be your second job.

Be assertive if your minimum terms of employment cannot be met. The job may not be a fit for your current situation. Your situation may change in the future and a similar position in the healthcare facility might be a fit, so you don’t want to burn bridges. Plan to point out the conflict to the nurse recruiter at the appropriate time during the pre-employment process. Bring up the conflict sooner rather than later because the nurse recruiter doesn’t want to spend time and money continuing with your pre-employment process if you already know there is a conflict that prevents you from accepting a job offer.

Prepare for the Online Pre-Employment Tests

Online medication administration tests that some healthcare facilities use during the pre-employment process follow the NCLEX style of questions. There are three parts to the question: the stem, the case, and the distractor. The stem is the portion that asks the question. The case describes the situation. The distractor is either a wrong answer or not the best answer. It is critical to identify these parts of the question before selecting a response.

Identify keywords or phrases in the stem of the question. There may be many words in the question but only one or two words that are important for answering the question. This helps to focus on the aspect of the problem that you need to address. Key words or phrases in the stem or a synonym may appear in the correct answer too.

Here are a few hints that may help narrow your focus on the likely answer to the question:

There will likely be questions requiring you to prioritize your response. These usually have words such as “first” or “initial.” However, the question doesn’t usually give you any clues on how to prioritize your response. You should be able to prioritize by using the ABCs, the nursing process, or Maslow’s Hierarchy of Needs:

Don’t look for cookie-cutter accuracy when trying to apply ABCs, the nursing process, and/or Maslow’s Hierarchy of Needs in answering a question that involves prioritizing. These are general guidelines that help to prioritize your actions. You are expected to apply your knowledge and not simply repeat facts. You are to find the best answer not the right answer.

Also remember the rights of medication administration if the question is on this topic. There are seven rights: right medication, right patient, right dose, right time, right route, right reason, and right documentation.

Remember to use the five “Ps” of assessing fractures if the stem involves a fracture. These are pain, pallor (poor circulation), pulselessness (poor circulation), paresthesia (burning or prickling sensation indicating a neurological problem), and paralysis.

Let’s say a patient returns from surgery to her bed in the medical-surgical unit and you are her nurse. Before reading the stem, focus on what you know about surgery – any surgery. You want to assess the patient – check breathing, check level of consciousness, monitor vital signs, make sure there is no bleeding at the surgery site or internally, make sure that the patient is not in pain, take precautions to prevent blood clots (that is, apply the leg massaging pump), elevate the head of the bed (if appropriate), check for normal capillary refill and relatively normal color, note the presence of a pedal pulse. Next read the stem and the case. The answer may involve following the standard nursing process following surgery.

Understand what is normal for the patient at that time by determining the timeline before answering the question. An answer may be irrelevant depending on the time. For example, you would expect your patient to be in pain 24-hours following surgery but probably not five days after surgery. Pain days after surgery may indicate that the patient is experiencing complications.

Eliminate two answers that don’t seem to involve post-surgery care, then focus on the remaining two answers. Think of each question as a true or false statement. If the statement is true, related to the surgery, and seems to answer the stem, then you’ve found the correct answer. If the statement is false, then the remaining question is the correct answer. Any exception to the stem indicates that the answer is likely incorrect.

Don’t overanalyze the question. Don’t assume facts not stated in the question. Usually the most comprehensive, therapeutic, age appropriate, reasonable and patient-centered answer that is within the nurse’s role is correct. Strange answers that are exceptions to common nursing practice are likely incorrect answers. The obvious answer or the answer that will cause the least harm to the patient is likely the correct answer.

Pre-employment tests usually don’t ask multiple-choice type questions where you are expected to select possible answers to the question from a list of items. However, you should be prepared to answer such a question should one appear on the test. Keep in mind that selecting one incorrect item or failing to select one correct item will make your answer incorrect regardless of whether you correctly select others on the list. A good approach is to focus on each item individually, asking if the statement is true or false based on the stem.

Prep for the Technical Interview

In addition to being prepared for pre-employment tests on your nursing knowledge, you’ll need to prepare for technical interviews by the hiring nurse managers and other staff who want to learn the level of your nursing knowledge. Technical interviews are informal. Questions may not be formally vetted for clarity and accuracy. You can be asked anything about nursing. And your response to questions may be subjectively evaluated. You don’t know what is a passing score, the interviewer may not have defined a passing grade either. Passing might be the overall impression that you leave with the interviewer.

Challenging as a technical interview may seem, you still have to prepare to answer questions to the best of your abilities — and your best may not be adequate to pass the technical interview, especially if you are an inexperienced nurse. You are probably an excellent nurse, but it might have been a while since you’ve been quizzed on details (by the book) of nursing. You likely take shortcuts that pose no harm to the patient but you wouldn’t pass muster if your nursing supervisor, or nurse professor, was watching you.

Furthermore, you have no clue as to what you might be asked. The remaining chapters of this book will help you prepare for both technical pre-employment tests and technical interviews. Questions tend to focus on critical thinking skills and patient safety rather than fine details of nursing procedures or medications. You probably know the answers, you might simply need something to jog your memory. You’ll find those memory-joggers in the next few chapters.

Chapter 7 focuses on medication and medication administration. Four types of medication commonly administered on practically all types of units are reviewed. These are antihypertension medication, diabetic medication, antibiotics, and pain medication. In addition, you’ll review the basics of safe medication administration. Chapter 8 concentrates on nursing skills.