Best unit to start for new grad?

[SamMo]

Hello all,

I have been a long time reader of allnurses but this is my first ever post. I just graduated nursing school earlier this month and I have been blessed with two opportunities already. I wanted to see if I could get some feedback from nurses new and old on what would be the best fit for a new graduate nurse with no experience. Here is what I'm looking at. If you can think of any other questions I might want to ask that would be great as well.

1) Progressive Care Unit- 4:1 patient to nurse ratio, 8 weeks of orientation. Mostly cardiac patients.

2) Oncology/Nephrology Unit- would learn both areas 6:1 ratio, 12 weeks of orientation

I never dreamed I would have a choice for my first nursing position. Both are working nights, both are approx 5 miles from my home, I am new to the area so not sure which is considered a better hospital overall. Also would like to add that I enjoy psych and if asked I would say that would be my first choice.

Any thoughts/opinions would be appreciated!

[SmilingBluEyes]

Well, what does your heart tell you? You can start anyplace, really, and learn a lot. What most interests you?

[quixotic.dy]

First, Congratulations on your job offers! It's refreshing to read about someone getting a job offer instead of the opposite.

I'm still a student, so no experience to advise from, but which one interests you most? If I was presented with these options I'd take oncology/nephrology simply because I'm more interested in those cases than cardiac.

All my recently graduated friends tell me you learn so much no matter where you start so they're all good options.

Good luck with your decision :)

[Corey Narry, MSN, RN, NP]

Hi there, glad you took the plunge and wrote your first post.

Unfortunately, I would find it hard to decide myself. Both are not your area of interest and though one has a better staffing ratio, the other has a longer orientation and would presumably be less intense as a PCU with a large cardiac patient population. However, I could also assume that the Nephro/Onc Unit would be busy just from my own observation of Hema-Onc patient who are on chemo in the hospital who have a host of complications from it.

One thing I would consider is which hospital has better benefits and ease of transition between units.

[Lev, MSN, RN, NP]

Oncology patients are not easy med surg patients. Many are terminal or DNR and therefore should be on a stepdown unit but are on med-surg since they're DNR or for discharge to hospice. I work med-surg/oncology PRN and our ratio is 1:5 days or nights. Sometimes I'll have 4 patients and on rare occasions 6, but that's when one is for discharge. 1:6 is tough. Sounds like they will give you adequate orientation which is great, but you should make sure staffing is ok before you accept the job. Make sure 1:6 is max and you don't frequently go up to 7 patients.

As far as PCU goes, 1:4 is an average ratio, but the length of your orientation is a little troubling. Again, make sure that they are planning to stick to those ratios. It could be that staffing is bad, so they want you off orientation quickly and therefore are offering you a shorter orientation time.

Orientation time is tricky though. The main orientation time that counts is time on the floor. Is the med-surg job part of a nurse residency program and the PCU job is just going straight onto the floor with a preceptor?

My advice is to ask for a shadow day on each unit to check things out. Definitely ask the PCU nurse manager for more orientation time.

[SierraBravo]

As far as PCU goes, 1:4 is an average ratio, but the length of your orientation is a little troubling.

THIS!!!!! There is virtually no way possible that 8 weeks is enough time for orientation to a progressive care unit/step down for a new grad.

[dishes, BSN, RN]

Of the two choices, which has the greatest number of experienced nurses? A unit that is staffed mainly with experienced nurses, is a better choice for a new grad, than a unit that is staffed mainly with novice nurses.

[Lev, MSN, RN, NP]

Another thing to look at is the quality of the hospitals. How are their HCAHPS scores? Hospitals with low HCAHPS scores are under STRESS. I know, because I just left one (for a much better hospital). You can look up HCAHPS scores here.

[SamMo]

I agree, the orientation time for PCU is what concerns me most about that position. I'm scared that would not be enough.

[SamMo]

I think that is a great idea to shadow first. Both told me patient ratios are strict so I shouldn't go over. I believe the PCU is straight to the floor with preceptor. The med/surg director said she is going to try to get me on as a nurse resident which is what I would really prefer.

[VANurse2010]

I agree, the orientation time for PCU is what concerns me most about that position. I'm scared that would not be enough.

8 weeks is not enough for step-down. I'd ask for more orientation - a refusal by the NM would be a red flag.

On the other hand, oncology/nephrology sounds like my version of hell - especially at 6:1. Sounds like a lot of social/family issues (oncology) and psych issues (renal).

[calivianya, BSN, RN]

8 weeks is not enough for step-down. I'd ask for more orientation - a refusal by the NM would be a red flag.

On the other hand, oncology/nephrology sounds like my version of hell - especially at 6:1. Sounds like a lot of social/family issues (oncology) and psych issues (renal).

I have to agree with this second part by a factor of 10. I got floated to a renal floor a few times as a CNA in nursing school, and at that point I decided I would rather be homeless and live under a bridge than primarily work with renal patients. Hey, though... you like psych! A renal floor might be the closest thing you can get to psych without actually working in psych.