My Reasons For Avoiding The Acute Care Hospital - page 5

by TheCommuter 19,938 Views | 56 Comments Senior Moderator

Iíve been asked the same question by members of Allnurses.com, real-life coworkers, and even some of my own family members: ďWhy arenít you interested in working at a major hospital?Ē My relatively short nursing career... Read More


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    Quote from TheCommuter
    Iíve been asked the same question by members of Allnurses.com, real-life coworkers, and even some of my own family members: ďWhy arenít you interested in working at a major hospital?Ē My relatively short nursing career consists of experience in long term care, rehabilitation (acute and sub-acute), and psych. For the past two and a half years Iíve been employed at a small specialty hospital that provides acute rehabilitation services, and to be honest, I think it's wonderful when a patient discharges to home with the ability to walk and talk when he was bedridden and unable to speak just two weeks ago. My career is about to traverse into a new chapter when I enter the realm of developmental disabilities nursing starting next week. Twelve years ago, when I was 19 years old, I was employed as a direct care staff member and caregiver at a group home in a residential area that housed six developmentally disabled clients. I mostly enjoyed working with this particular patient population and will be thrilled to finally work as a nurse in this specialty. Meanwhile, letís venture back to the original question. . .Why do I not want to work at a major hospital? Honest introspection is a major part of my career decision. In addition, my experiences while attending clinical rotations during nursing school at multiple hospitals in two different states cemented my choice to avoid acute care like the plague, especially after seeing how appallingly the nurses were being treated. After much painstaking self-reflection, I realize that an acute care hospital job is not for me. Some people would interject and say, ďWell, youíll never know unless you try it!Ē To be perfectly blunt, I know my personality is not compatible with acute care. Iím a mellow type B girl who does not like responding to codes. I dislike dealing with changes in condition. I detest taking off orders that constantly change on the whim of the doctor, nurse practitioner, or physicianĎs assistant. I cannot stand constantly performing procedural skills such as IV starts, Foley catheter insertions, nasogastric tube drops, or blood draws. I despise having to drop what I'm doing to address a stat order. I do not look forward to constant interaction with physicians, families, dietary staff, visitors, RT, and other people. I hate the liability involved with acute care. I do not enjoy the idea of not knowing exactly what I'm going to walk into. I do not like making decisions NOW, and in acute care the nurse must make decisions NOW. Acute care involves a pace with which I'm not comfortable. Iím not an adrenaline junkie. My preferences include low acuity patients, low liability, minimal stress, and the same old routine. I know that several years of acute care hospital experience would be vastly beneficial to my career as a nurse. After all, you donít know what you donít know. However, if I would likely be unhappy during those years, why follow through with it? If I could steer clear of the acute care hospital for the remainder of my career, I'd be content. Some uninformed people insist that real nursing only takes place inside the walls of the acute care hospital setting. People can think whatever they darn well please. As long as Iím happy, secure, and comfortable with the work Iím doing, thatís all that matters to me. Patients outside the hospital setting need nurses, too.
    When possible I think a nurse should have 2 years experience in the hospital. The skills u learn in the hospital is a huge benefit to the rest of his/her career. I have done hospital and non hospital nursing roles. When I work with nurses that do not have hospital experience I feel you see it in there assessment skills and organizational skills. I do agree with the post that there is a major sector outside of the hospital where nurses are using there nursing skills every day. Thank you for the article i enjoyed it so much I register. ;0)
    TheCommuter likes this.
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    I am struggling myself after having moved from California back to the south where there are no staffing ratios. It is important to me to be an awesome nurse. I've been doing this for over 16 years and thus far I have never uttered the words "I'm too busy" to a patient. I feel like the current staffing with this level of acuity truly sets people up to fail. The experiences I have had with family members in the hospital and what I see as a staff nurse myself scares me to death!
    noyesno, joanna73, VICEDRN, and 1 other like this.
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    Like all people...nurses have preferences on the type of practice they wish to do and what type of care facility they want to work in. Some because it fits with their knowledge, others because maybe they had the same issues and wish to use their experiences to help heal and care for others with the same issues or disabilities and then, some just want an easy job, where they can just slide by and get a paycheck. Myself, I take the opportunity to work at any type of facility/setting. It allows me to gain new skills and furthers my knowledge which can only make me a better nurse. There are many avenues to take as a nurse..hence many opportunities to make you that much more better and experienced in different aspects of nursing, therefore, I feel you shouldn't limit yourself to one type of care facility or nursing area..but again..it's based on individual preference.
    TheCommuter likes this.
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    Well written!! I wish I knew of all these other avenues besides hospital nursing that nurses can explore and enjoy working in. I fell for this same fallacy and am miserably working in acute care. The demands become greater and greater, while our resources and staffing keep getting cut. I almost quit wanting to be a nurse b/c of this kind of environment
    joanna73 and TheCommuter like this.
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    I enjoyed reading your post. I agree that not all nursing, or rather, "real" nursing only happens in an acute care hospital. I have only worked in hospital settings: Med/Surg, Telemetry, ICU, ER, and Psych. While some would argue Psych isn't "real" nursing either, I beg to differ! Just because you are not starting IV's, dropping NG Tubes, and giving bedbaths before or after a "Code Brown", Psych nurses must have knowledge and good assessment skills regarding the medical conditions many psych patients have. We also are giving medications of all kinds, although only orally or by intramuscular injection. And psych patients can "code" just like anyone else might anywhere. As a nurse, you must know how to handle a medical emergency. I went into nursing as my second career because I wanted job security that I felt I could only achieve in nursing. Nurses work everywhere. And now I am back in school in order to become a Nurse Educator. I have to for financial reasons, work as long as I can. I can see myself still working in some nursing capacity, such as teaching, well into my 60's. I do not believe in mandatory retirement as long as you are doing what you love, and I love nursing.
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    I understand you completely. I already worked my butt off in acute care. Now it's time for less stress.
    roseyone, joanna73, and TheCommuter like this.
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    Lol you're not alone OP. I could have written your post. I've worked acute care, and while I value the experience, I knew in nursing school acute care and emerg aren't for me. Could I handle it? Yes. Do I want to? No. I prefer areas where I can spend time with my patients and provide good care while teaching them how to live healthier. Fortunately, nursing offers something for all of us.
    TheCommuter likes this.
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    Wow, I am so glad there are other nurses that feel that same way. I have been a nurse for two years working in corrections. I am at that point where i want some new experience but the thought of acute care doesnt really appeal to me. I just fear that without acute care experience i will be limiting myself. I fear that 10 years down the road i will regret not getting experience in acute care, by then it will be to late and no one will wanna hire someone with no experience. I was thinking of taking small steps and apply to rehab hopsital or maybe medsurg to get my foot in the door and learn some new skills. Thanks again for helping me realize there are other nurses that feel the same way about acute care

    Quote from TheCommuter
    Iíve been asked the same question by members of Allnurses.com, real-life coworkers, and even some of my own family members: ďWhy arenít you interested in working at a major hospital?Ē

    My relatively short nursing career consists of experience in long term care, rehabilitation (acute and sub-acute), and psych. For the past two and a half years Iíve been employed at a small specialty hospital that provides acute rehabilitation services, and to be honest, I think it's wonderful when a patient discharges to home with the ability to walk and talk when he was bedridden and unable to speak just two weeks ago.

    My career is about to traverse into a new chapter when I enter the realm of developmental disabilities nursing starting next week. Twelve years ago, when I was 19 years old, I was employed as a direct care staff member and caregiver at a group home in a residential area that housed six developmentally disabled clients. I mostly enjoyed working with this particular patient population and will be thrilled to finally work as a nurse in this specialty.

    Meanwhile, letís venture back to the original question. . .Why do I not want to work at a major hospital? Honest introspection is a major part of my career decision. In addition, my experiences while attending clinical rotations during nursing school at multiple hospitals in two different states cemented my choice to avoid acute care like the plague, especially after seeing how appallingly the nurses were being treated. After much painstaking self-reflection, I realize that an acute care hospital job is not for me. Some people would interject and say, ďWell, youíll never know unless you try it!Ē

    To be perfectly blunt, I know my personality is not compatible with acute care. Iím a mellow type B girl who does not like responding to codes. I dislike dealing with changes in condition. I detest taking off orders that constantly change on the whim of the doctor, nurse practitioner, or physicianĎs assistant. I cannot stand constantly performing procedural skills such as IV starts, Foley catheter insertions, nasogastric tube drops, or blood draws. I despise having to drop what I'm doing to address a stat order. I do not look forward to constant interaction with physicians, families, dietary staff, visitors, RT, and other people.

    I hate the liability involved with acute care. I do not enjoy the idea of not knowing exactly what I'm going to walk into. I do not like making decisions NOW, and in acute care the nurse must make decisions NOW. Acute care involves a pace with which I'm not comfortable. Iím not an adrenaline junkie. My preferences include low acuity patients, low liability, minimal stress, and the same old routine. I know that several years of acute care hospital experience would be vastly beneficial to my career as a nurse. After all, you donít know what you donít know. However, if I would likely be unhappy during those years, why follow through with it? If I could steer clear of the acute care hospital for the remainder of my career, I'd be content.

    Some uninformed people insist that real nursing only takes place inside the walls of the acute care hospital setting. People can think whatever they darn well please. As long as Iím happy, secure, and comfortable with the work Iím doing, thatís all that matters to me. Patients outside the hospital setting need nurses, too.
    TheCommuter likes this.
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    When I started critical care, I was fascinatd by ABGs, ECGs, EEGs, labs, vents; to the extent that I would awake before the alarm. I could not wait to get to the hospital and continue learning.

    I worked in California in a pulmonary ICU during the first wave of AIDS (1984/85). A few of the nurses on my unit refused to care for AIDS patients. (I think, at the time, it was called GRID or another acronym.) Some of the nurses were pregnant so I didn't blame them. We were all in the dark about the disease.

    I did not refuse to care for AIDS patients. I met amazing men with wonderful histories and stories to tell. I wept when they passed.

    We nurses drew our own ABG's when the patient was too fragile for an A-line.

    One of my patients was a young woman (19) who was stabbed during a fight with another woman over a boyfriend. She developed ARDS and was on a vent for weeks. She recovered. We made that happen for her.

    There were Swan-Ganz (PA line) insertions at the bedside. I admired the doctors so much.

    When I worked in that unit, the nurse/patient ratio was 1:2.
    NurseMoi likes this.
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    I too have not worked in acute care. Could I? Yes and I could be good at it but I knew before I went to nursing school that I wanted to do maternal-child public health. I wanted time to do health teaching and to have long-term relationships with my patients. I got the "you really need to do a couple years of med-surg" from instructors and other nurses. Their rationale was that it taught you skills you would not learn in other jobs. When I asked if aspiring acute care nurses needed to do public health, rehab, long-term care etc to develop skills they wouldn't learn in acute care, they usually just looked at me like I was weird. I told them, "No nurse can know it all. There is too much information and care is too complex. If you are a cardiac nurse, you develop that skill and knowledge but do not know maternal-child or peds. You develop a skill set in whatever nursing job you do. You can't know or do it all." I was 51 when I graduated. I did not want to waste a couple years doing a job I did not like. After 9 months in a peds clinic, I got my ideal job in public health working with pregnant and parenting teens - exactly what I wanted to do. I have autonomy, do lots of teaching, face unexpected challenges daily and my job is never boring. Is it easier than acute? NO! It is just hard in different ways but I love it. Some nurses with hospital experience try it and find it is not a good fit for them - they may not like being without backup, going into strangers homes in not great areas of town or they miss the adrenaline rush. The great thing about nursing is you can find an area that fits you. I appreciate all the great acute care nurses I know. I'm just not one of them.

    Might I regret done the road that I did not do acute care? Maybe but I for sure I absolutely would regret spending time doing acute care. Am I a "real nurse"? Yes. I use the nursing process every day. I don't give meds but I do a lot of teaching. I advocate for my patients when they are not receiving the care they deserve and need. I educate about a wide variety of subjects - not just the teen mom but other family members as well. I am a real nurse and I love what I do. I hope those of you who don't love your job can find one that is a good fit for you.


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