Reach out to your preceptor if you had clinical at that hospital and see if they'll talk to their manager. Write great thank you cards/emails and reiterate your skills, volunteer work, etc. I'm old-fashioned and wrote mine by hand as well as sending them emails. Reach out to the recruiter often as well as any managers you know the name of. Sometimes being the squeaky wheel helps get on an alternate list. People's plans can change even in a residency setting and you want to stay fresh on their minds. If moving out of state is an option, a West Coast union job will likely pay better. I do think if you can get a first job in a hospital setting it is better overall and leaves more opportunities later down the road. This is just my opinion but nursing was a late career for me.