jennah982. . .i worked as a nursing assistant in a nursing home as a student. because of some problems after graduation i ended up working in the same home as a graduate rn. so, you could say that i started my career in nursing homes. i spent my last four years working in a nursing home before i finally had to stop working as a nurse. i have been an rn since 1975. i spent most of it working in acute hospitals. i have been a staff nurse and manager in both nursing homes and the acute hospitals. however, i often went back to my "roots"--nursing homes--to earn extra money or when i moved to a new town and couldn't find a hospital job (yes! that did happen!). so, what i am going to tell you comes from the knowledge of experience and having worked in both venues.
i think that nursing homes have a great deal to teach nurses; and, i think that the acute hospitals have a great deal to teach nurses. you will develop different skills in each type of setting. i think the training in both types of facilities has given me unique training and experience. in a nursing home you are going to become a real expert on addressing adls (activities of daily living) and maintenance care. this is what nursing homes specialize in. they also do very well at end of life care for those who have chosen not to do all the fancy things to stay alive as long as possible. this is something that many acute hospital nurses are not very versed in. their focus in many situations is to keep people alive at all costs. as a charge nurse in a nursing home you will learn and become more skilled in how to organize your time because you will have many tasks that need to be done within a short amount of time for a much larger group of patients. as a charge nurse you will be developing and utilizing many of the roles of the nurse that you are going to learn about in school: care giver, change agent, leader, client advocate, coordinator and collaborator. many times acute hospital nurses don't get to fulfill as many of those roles as often as a nursing home nurse does and their focus is primarily on being a care giver, doing some health teaching and some advocacy on a case by case basis as a problem comes up. in nursing homes you get to know your patients because they are long-term residents. you learn to hone your assessment skills because, like children and pets, elderly adults cannot always articulate what hurts or is bothering them. so, you learn to observe their behavior. the opportunities for advancement and to have autonomy abound in nursing homes. it is where i started developing an interest in and becoming good at writing care plans, something that many nurses would rather sweep under the carpet. a charge nurse in a nursing home is a true manager, not only of their patient, but of the subordinate staff as well. hospital nurses do not normally participate in the supervision of the subordinate staff who work with them at all.
in the acute hospital nurses become very good at mastering hands on treatment skills. things like inserting various kinds of tubes and catheters and how to care and troubleshoot them. lets not forget about starting, maintaining and giving iv fluids and blood transfusions. they help to prep patients for tests, take care of patients in the acute phase after surgery and other procedures. they see doctors visiting patients every day and are responsible for making sure that the doctor's orders are carried out and that is a very big focus of their job. their patients are coming and going all the time so the pace is very fast and the climate can change instantaneously. they may only know a patient for one shift and then they are gone. in nursing homes you get to know your patients very well and have input into managing their care. things change very rapidly in acute hospitals. new equipment comes along that you have to learn how to use. the hospital suddenly changes the medical supply company it uses and you have new supplies to work with. hospitals are busy places with all kinds of healthcare personnel scurrying around working with your patients as well as you. you also have to be organized, but in a bit of a different way because your immediate situation can always change drastically within minutes.
if you decide to stay with the nursing home, and i can't imagine why you wouldn't if they are going to pay for your education, you can always go to work in a hospital later. the way you will do this is to take an rn refresher course. these courses are specifically designed to get you updated to what a hospital nurse does as well as put you into clinical practice sessions in hospitals that are recruiting rns and keeping an eye on the rn refresher students for any that seem like potential nurses they might want to put on their staff (hint, hint).
as i mentioned i went to work for the nursing home that i worked in as a nursing student. after that i got a job working in two of the hospitals where i had done my student clinicals as a nursing student. however, for years i wondered what it would be like to work for a huge city teaching hospital. i worried that maybe working in community hospitals and nursing homes wouldn't qualify me. boy! was i wrong. i happened to move to another city 500 miles away and thought, "what have i got to lose?" and applied to a huge tertiary care hospital and was hired that same day! what an experience it was working for that organization. my background had more than prepared me. i have never forgotten or poo-poo'd my nursing home roots. you will hear me talk about it proudly here on the forums. i learned a great deal about organization and management from working with the elderly nursing home folks. and, i hope that in return i gave back to those residents as good as i got from them. i don't believe that there are any nursing jobs that are more selective than any other. it's all in people's minds. what you get from any position is what you put into it. if someone keeps telling me how rotten one of their jobs was, it's just in my nature to wonder why they aren't talking about what they tried to do to help make it better before they gave up and quit. keep your thoughts positive and look for the positive and you'll come out ahead--not in a rut of a career as some people would like you to think. there is something to learn that you will carry with you forever from every experience. anyone who tells you that starting off in a nursing home is a dead end is handing you a bunch of crap. i'm hear to tell you so.
good luck with nursing school. be good to your nursing home residents because they need you. think positive. see you on the forums.