There are few things clinicians dread more than negotiating an employment contract. The sight of blood doesn't faze us, but we go weak in the knees at the thought of talking with an employer about our potential salary and benefits. I am not an attorney, so I won't give you legal advice. But I am a nurse practitioner and I was a successful recruiter for several years, so I can share a few observations, some lessons learned, and some practical advice.

Wait for the Offer

Don't start negotiating until a formal offer has been made. The interview is not the time to start bargaining. It's OK to answer honestly if your interviewer asks you a direct question about salary or compensation expectations, but don't mistake that as an opening to start negotiating. Serious offers should be made in writing. An employer may call to extend an offer, but this should be followed by a written offer. No matter how many options and scenarios you and the employer discussed, until the offer is in writing, you have nothing but promises.

Go for the Gusto

Don't be shy. In business there is a saying that "you don't get what you deserve, you get what you negotiate." Remember that healthcare is a business, so once an initial offer is made, it's perfectly acceptable to have a little back-and-forth discussion about the terms. Employers won't be surprised if you have additional requests. If the negotiations become contentious or emotional, take a step back and try to be more objective. Reassess and reevaluate before proceeding.

Decide What You Want

You cannot have an effective negotiation unless you know what you want. Before you begin your job search, make a list of your "must haves." You won't (and shouldn't) expect to get everything you want in a negotiation, so you should put serious thought into what you can live with and what you can live without. This is your "walk away," because it represents the least amount in salary and/or benefits that is acceptable to you. If an employer is unable or unwilling to meet what you have determined to be your minimum terms, it is best that you gracefully decline.

Note that I said "gracefully." Resist the urge to lecture or school the employer on why the offer has fallen short. You don't want to burn any bridges.

Make Reasonable Requests

Be reasonable in your requests. This is especially true if you are a new grad. Employers are put off when new grads push too hard for salaries on the upper end of the scale. You are an unknown quantity and quite honestly, a bit of a gamble.

I have seen job offers retracted when the demands are too numerous or too high. Experienced clinicians shouldn't ask for a high salary package without the data to back up the price tag. Be diligent about keeping records of your productivity and the revenue you generate.

Need for Speed

You can speed up negotiations by not negotiating. That's right. There are two ways to reach an agreement. One is the "horse trading" method, in which both parties barter back and forth. The employer makes an offer, you counter the offer with an amount that is higher than you expect, and the employer counters your counter. (Wash, rinse, repeat.) By the time the negotiations are finished, you end up somewhere in between.

If that process is not appealing to you, choose instead to share your salary expectation and give the employer the option to accept or decline it. This is the method preferred by many seasoned clinicians who, based on past employment experiences, are very clear about what they want. Employers also appreciate the honesty and clarity of this approach.

Acceptance

Sometimes the first offer is a perfectly good offer. There is no shame in accepting the first offer if it is reasonable. Don't negotiate for the sake of negotiation.

Need a little time to make up your mind? It's acceptable to ask for up to a week to make your decision. Provide a concrete date by which you will provide your answer. Under no circumstances should you leave an offer hanging out there without a response.

Renee Dahring is a family nurse practitioner who practices in correctional settings in Minnesota. She has experience as a recruiter and now conducts workshops on resume writing and interviewing.

Final Takeaway: Negotiation Don'ts

• Don't be shy about identifying what you want.
• Don't make unreasonable demands.
• Don't criticize the employer for making an offer you don't like.
• Don't be afraid to accept the first offer.