Including Letter of Recommendation?

[No Derate]

Hello, my wife and I just moved to a new location and she is applying for jobs in the medical field. There aren't a lot of job listing available in this area for her specific field, so it's becoming quite the process. I'm curious if including a letter of recommendation along with a resume is an acceptable way to set yourself apart? The LOR would be from her previous boss, who is the department head at a large and highly respected hospital in St. Louis, MO.

Would including this seem desperate? Maybe she could just include the verbiage, "Letter of recommendation available upon request," in the resume? Seems like a heck of a tool to go unutilized.

Thanks!