Transcript: Monday, September 11, 1 p.m. ET

Helping Hands: Careers in Healthcare

Karen Haller and Pamela Paulk
Johns Hopkins Hospital and Health System
Monday, September 11, 2006; 1:00 PM

Skill, effort and luck can take you to the top of any field -- but it never hurts to get a little help. In our Helping Hands special feature, we've got plenty of assistance on tap: articles, tools and live discussions that will help you learn more about how to get ahead in the area's top industries or your career in general.

Healthcare is one of the Washington area's hottest career fields. Two experts from Johns Hopkins Hospital and Health System -- Dr. Karen Haller , vice president for nursing, and Pamela Paulk , vice president of HR -- took questions on the trends and opportunities.

The transcript follows below.


Karen Haller: Hello, I am the chief nursing officer at The Johns Hopkins Hospital and welcome your questions this afternoon. I am pleased to be here. Let's get started!


Washington, D.C.: I've heard that qualified nurses can essentially find work just about anywhere (geographically) that they want in the U.S. Is this true, or close to true? Or are there regions that I shouldn't bother trying to move to because of high supply of graduates?

Karen Haller: There is a national nursing shortage, affecting all regions of the country and providing opportunities for employment across the 50 states. Having said that, there is some variability by area of the country. New England has the highest concentration of employed RNs in relation to the area's population; and the Pacific Coast has the lowest concentration.


Washington, D.C.: What nursing specialties are likely to see the most growth in demand over the next 10 years?

Karen Haller: Growth in demand for nursing services in all specialties (not shrinking supply of RNs) is fueling the nursing shortage. I anticipate most growth in specialties that serve our aging population, such as gerontology and cardiology; but we are also hiring in pediatrics and other fields.

There is high demand in emergency departments, critical care units, and operating rooms.

In addition to hospitals, nurses are hired to work in ambulatory care, community health, the armed services, research, etc. All of these areas have been growing as well.


Washington, D.C.: I am in my mid 30s and have completed a master's degree in a field which I work, but I am seriously considering going back to school to become a hospital nurse. What are the education requirements for RNs? What about LPN? Is it unusual to have second-career nurses?

Karen Haller: Education requirements for entry into practice as an RN include both an Associate Degree and a Baccalaureate Degree, with more opportunity available to those who have earned the Baccalaureate.

For someone like you, who holds an advanced degree in another field and has work experience, there are also accelerated degree programs in nursing. To locate programs in your area, check or the American Association of Colleges of Nursing at

You might be interested to know that two-thirds of the students entering Johns Hopkins University School of Nursing already hold a bachelor's degree in another field and a substantial number have previously pursued other careers before choosing nursing. Among those in our Accelerated Class of 2007, who started in June, 12 percent of the 165 students hold advanced degrees, including two who had previously earned a PhD.


Washington, D.C.: Hello,

I am currently working on my MPH/MBA and am trying to get a position that is related to my degree. I am anxious to find a position that will allow me to utilize my degree. I also need to do a internship and I am having problems finding sources or anyone that will give me a chance since I have no previous experience in this field.


Pamela Paulk: Check with your school for organizations that they have relationships with. Many MHA prgrams have one-year residency programs with them. The residency will give you a year of experience as an extension of your education. It is a great way to get started in your field. Employers love residents.


Alexandria, Va.: I have been working in rhe communications field with an emphasis on public and environmental health.

Would pursuing a masters degree in public health degree qualify me for more senior jobs in public health communications? I am wondering whether to invest the time or money or simply seek out positions with more responsibility and learn on the job.

Pamela Paulk: A Masters degree in Public Health is a great general degree to have. It will open plenty of doors. You will have to demonstrate your specific knowledge and skills through your work.


Washington, D.C.: After the baby boomer generation subsides, will there be a glut in health care providers?

Karen Haller: The shortage of healthcare workers is projected to continue until 2020! Remember that many of us who work in health care are boomers, so we need to replace our numbers as well as staff the increase in demand. The increase in demand is not just attributable to an aging population, but also to increased technology, a rise in infectious diseases, and the need to serve as "first responders" in disasters.


Washington, D.C.: What degrees are desireable to: formulate healthcare policy, run a hospital, work at CDC as an epidemiologist? Thanks!

Pamela Paulk: Well, epidemiology is a very specific field. School of Public Health offer concentrations in that which will make you well qualified. Many degrees are useful in running a hospital or formulating health policy. I have a Masters in Social Work and a Masters in Business Administration, so I have both bases covered! The MHS or MHA is a great general degree as well.


Washington, DC: How well are online degrees regarded opposed to traditional learning?

Karen Haller: In nursing, online courses are regarded well and recognized. However, nursing programs also teach clinical skills in simulation labs and with real patients. Clinical practicums on-site are required to do this.


Baltimore, Md.: Can you make a career in interior design or interior decorating in the healthcare industry at Hopkins?

Pamela Paulk: Most people with that expertise work for consulting companies or architech or design firms that specialize in hospital interior design. Most hospitals don't have enough internal work to have that as a full-time position. Hahaha, if you saw some of our old buildings you would say that we need one here!!


Rochester, N.Y.: I have a NY state nursing license (RN). Is it transferrable to other states? How do I go about getting licensed elsewhere?

Karen Haller: As you know, nursing practice is regulated by the States. The Board of Nursing in each State issues nursing licenses. Some States are known as "compact" States, because they recognize the licenses of other States in the compact. Other nurses moving from State to State need to apply for a license in the State to which they are relocating. Call your State Board of Nursing, or check their web site, to determine the procedure that applies to your particular situation.


Washington, D.C.: Would you both describe your trajectories. What led you to your respective positions?

Pamela Paulk: I started with an MSW and worked for many years in the mental health and substance abuse field. I ran a non-profit and was the administrator of a psychiatric hospital. I also was an internal consultant for a psychiatric company and then moved to external consulting for healthcare in general. I came to Hopkins in 1998 in a role much like a consultant, working on projects for the organization at large. Luckily for me, Hopkins decided to try something different with Human Resources and choose someone who came from the operations side. So in 2000 I became the VP of HR. I don't know why I didn't do this years ago. HR is a great place to be.


Washington D.C. : I am a C.P.C -A (certified professional coder-apprentice) , and I would like to know what would be the best way to get my foot in the door in the industry? Most companies want three to five years experience.

Pamela Paulk: Most organizations do require an appenticeship first to get you to a defined quality and productivity level. Those levels usually only come with experience. Consider contacting the larger healthcare providers and ask them if they have apprenticeship positions open. We do here, but we use them mostly for our own employees who are in our incumbent worker program to learn a new skill and profession.


Washington, D.C.: What sort of hours, and how many, should a "new" RN expect to work?

Karen Haller: Newly minted RNs working in a Hospital should expect to do some shift work (evenings or nights), a fair share of the weekends, and some holidays during the year (but not all of them!). The specifics about working hours should be discussed, negotiated, and understood before accepting a position.

Some nurses negotiate schedules that accommodate child care, school schedules, etc. There is usually a trade-off to be made, for example, picking up more weekend shifts. Again, these should be negotiated during the interview process.

A full-time position in nursing is 40 hours per week, but there are many part-time opportunities available.


Annapolis, MD: HELP! I'm currently at the tail end of completing my Masters in Healthcare and currently employed as an office manager for an major pharmaceutical firm. What jobs can you suggest for someone like me who would to utilize what they've learned? I'm currently applying for various managments jobs now; however, I'm getting a little frustrated.

Pamela Paulk: I would need a little more information about years of experience and type of jobs held to really help you. The Masters opens doors for you that may not have been open before as some jobs will say "Masters required." Consider looking at jobs with "project" in the title -- project analyst, project administrator, project manager. That might be a way to get in the door without the supervisory piece. These jobs will use more of your academic training as well. Good luck to you.


Washington, D.C: My friend has a MSW and will be applying for hospital positions this spring. What are the benefits to working in a hospital, rather than in private counseling, in your opinion?

Pamela Paulk: I would not characterize it as an advantage of one over the other. I would say that your friend should consider the work environment he/she prefers. A private practice is usually one-on-one or small group work. You usually work alone or with a co-therapist. So it is suited for someone who likes a smaller workgroup. The hospital environment is more fast paced, a large multi-disciplinary team. Usually, the work is done at the bedside not in an office. So it is suited for someone who likes a bigger team environment and less structured workday.


Washington, D.C. : What are the reasons for pursuing an MD over an RN degree? And what have you both found most rewarding about your work? Finally, do you have liveable hours? Can you find life-work balance?

Karen Haller: The role of a RN is different from a MD, and it is a matter of what the best fit might be for each individual. The educational path is shorter for an RN, and the rewards are high. We recently polled students who were enrolling in our nursing programs, and asked them "Why did you choose nursing?" Nearly half of the respondents indicated that they made the decision to help and care for others; many others identified an interest in health sciences and the wide range of career options available in the field. Only a few cited the salary potential and job security created by the nursing shortage.

And, yes, I've always had liveable hours. I've balanced a marriage, child, exercise regimen, and outside interests with my career in nursing. It's not always been easy, but it has been deeply satisfying to serve patients and never ever dull!


Arlington, Va.: How have either of you used mentors, who were they? How did they help you?

Pamela Paulk: I think mentors are invaluable. Most people use secondary mentors that they go to for advise on specific topics. Career mentoring is the most common.

It is rare to find, but I value the primary mentor who is someone who knows you and tells you the truth and guides you through many aspects of work and life. I was fortunate early in my career to have a gentleman who did that for me. He was a fireman and I was directing a mental health agency, but he was able to tell me stories that always hit home for me. He helped me mature exactly when I needed it. He died a few years ago, I hope knowing how much he meant to me.


College Park, Md.: I have applied jobs of Data Analyst etc by submitting online at JHH. Is this the best way to apply? Do you have any other suggestions for me?

Thank you.

Pamela Paulk: Yes, even if you came into the office, you would have to go on line to apply. But if you want to make contact with a recruiter for advise on if you are applying for the right things, call and ask to meet with a recruiter for general advise.


Washington, D.C.: My mother often complained about her nursing positions since she felt that she spent much of her time with aides that weren't very well educated. Her advice to me was: find a field you love and then make sure the job has you surrounded by smart and interesting people.

Karen Haller: Your mother gave you good advice! Do find a field you love and surround yourself with smart people.

The demand for RNs continues to increase in part because the nursing care needs of patients have become more complex. Yesterday's nursing aides cannot meet the needs of today's hospitalized patients, so the number of aides has declined. We have to ensure that the right type of nursing personnel are at the bedside to meet the nursing care needs of our patients.


Gainesville, Fla.: Hello, I am in my last phase of my graduate study here at the University of Florida. I plan to relocate to the D.C. area upon graduation. In pursuit of a position in the healthcare communications field, am I less likely to be chosen for an interview if I am not in the D.C. area. I currently work in the Office of Public Relations and Communications at the College of Nursing and would love to continue in the healthcare field. Do you have any advice on the best way for me to obtain a position. Thank you!

Pamela Paulk: Hi, I am a Florida State graduate (1974 and 1978). You should not be at a disadvantage, but you should plan a trip up and make the rounds so that people can meet you. Networking can certainly help support your resume. Don't be shy about getting the names of all the Communications department heads and calling and ask for an appointment or send your resume to them. You only need one to get through. Follow all the traditional means of applying on line as well. Even if you don't see an opening that fits exactly, send your resume to get it in the system. Good luck to you.


Washington, D.C.: Do nurses specialize? Is it worthwhile for them to do that if they have niche interests? Also, a relative of mine is a Physician's Assistant, what are the benefits of that degree besides the ability to perscribe drugs?

Karen Haller: Yes, nurses do specialize. Many pursue advanced graduate degrees (Master's degree or doctorate) in a specialized area. Nurses with interests in "niche areas," as you call them, should specialize and build depth of knowledge in that area. At the end of the day, nurses are "knowledge workers." The more knowledge they develop, the more valuable they are to institutions . . . and to patients!

A physician's assistant (PA) is an extender for the physician's practice. They support medical practice and care for patients in many areas (e.g., operating rooms, intensive care units, procedure areas, etc.). They may prescibe drugs.

Similarly, nurse practitioners (NP) are nurses with advanced preparation. They may also prescribe drugs, and manage a case load of patients.


Washington, D.C.: It seems that teaching hospitals (at least in the District) are increasingly privately run (GWU, GU and Howard all are) does this make a difference as far as how it is administered? From an HR perspective, what changes have you seen?

Pamela Paulk: From an HR perspective, I see great public and private hospitals. I think the difference comes more from if they see employees as the invaluable asset that they are. That comes from leadership, not funding source or organizational structure.


Washington, D.C.: Does the shift away from aides to RNs mean that the quality of care is improving?

Karen Haller: There is a growing body of literature which shows that a higher proportion of RNs, and greater autonomy for nurses in the work environment, improves patient care outcomes. Both the quantity and the quality of nurses make a difference.


Washington, DC: What employment opportunties are available for a PhD in nursing other than teaching and research?

Karen Haller: We have nurses with PhDs in a variety of administrative positions, and also some who choose to remain in practice at the bedside.


Falls Church, Va.: I have a mental health background and worked in a variety of addiction treatment settings. Over the last several years I have done case management for cancer patients that are friends. I am very good at it. Is there a place for someone like me, without being a Registered Nurse, to do professional case management for oncology patients? Most of the case managers I have interacted with have been RNs or have MSWs. Thanks.

Pamela Paulk: Hmmm. Good question. Most case managers are nurses or social workers. I suggest you ask to see the job description. If it says, "RN or MSW required" then you need not apply. If it says nothing about degree or if it says "RN or MSW preferred" then it is not required and you could build a case in your cover letter why you qualify. Good luck.


Washington, D.C.: Is it still possible to work contract/freelance hours as an RN or are failities more interested in having people on staff? How might the pay scale differ for individuals in each case?

Karen Haller: Yes, it is still possible to work for a temporary agency that contracts with healthcare facilities to provide nurses. There will always be a need for some RNs who can freelance to replace staff who are out on leaves or to fill vacancies.

The pay to freelance can be higher for a relatively new nurse, but a seasoned veteran RN makes more in the hospitals now. In addition, hospital benefits are generally much more generous.


Baltimore, Md.: How come Hopkins employees have to pay $100 a month for parking even though Hopkins Hospital is considered a non-profit organization when it comes to paying taxes at the end of the year?

Pamela Paulk: This question is specific to Hopkins and would apply to other urban hospitals where parking is a premium. I am sure our parking office will be happy to answer if you contact them directly. But for everyone in a similar situation, parking structures are very expensive to build and one of the reasons that many hospitals have moved out of cities to where there is more land. You cannot pass the cost of parking on to the patient charge so the parker has to pay. Unfortunately, it is expensive and comparable to what people pay who work in downtown office buildings.


Karen Haller: Thanks to everyone who posed a question!


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