Big city hospital or small family-friendly hospital?

[Nurse Beth, MSN]

Hi Nurse Beth,

I am a recent graduate of nursing school. I am a second degree student with a young family. I applied to almost 100 jobs leading up to graduating and then right after. Our job market (Boston area) was hit with hiring freezes due to COVID. A neighbor handed in my resume to a small community hospital landing me an interview and I was hired on a med surg floor which is set to begin mid-September.

In the meantime, I received an email that I was selected to interview for a highly competitive slot in a critical care residency in a large Boston hospital. The interview is 2 weeks before I am set to begin working at the small community hospital. The residency would lead me directly where I want to be - critical care. However, the smaller hospital offered me the choice of evenings vs overnights to help accommodate my family which I think is huge as a new graduate. My question is - do I go for the big city hospital which would feed directly into my long term goal - making me a very small fish in a very big pond or choose a smaller hospital that pays less, would require me to jump through more hoops to reach my goal but that may offer more flexibility for my young family. And how will the small hospital perceive me leaving them before I even begin with such short notice. 

Dear Graduate,

CONGRATS on graduating and on landing 2 interviews and 1 job-so far! You do have a challenging decision to make if offered the second job.

Quitting before you begin is not ideal, but it's far better than quitting after you start. Still, the smaller hospital did hire you into a spot that could have been taken by someone else.

Flexibility for your family is no small thing, and it speaks to the culture of the hospital in a good way. Your hours and your commute are going to be highly important to your satisfaction with your job. It's also fortuitous that your neighbour turned in your resume which landed you a job.

However, residencies do offer you a great start as a new nurse. I would look at the length of orientation the small hospital is giving you. If it's around 10-12 weeks, that's a good length of time, even it isn't a residency.

As far as opportunity, I believe that a year or two spent on MedSurg in a hospital that values their employees and families will not deter from your long-term goal of critical care. This is assuming the smaller hospital has a good reputation and will provide you with plenty of support as a new grad.

I can only share with you my thoughts and values, and I hope it helps, but in the end it's your values that are important.

Best wishes in your decision,

Nurse Beth

[JKL33]

I think another nuance that should be considered is the specifics of your critical care goal. For instance, do you want critical care because you believe you like the kind of nursing that is done there (I.e. it's an end goal)? Or do you want critical care because you like the kind of nursing that is done there and also want to apply to an ACNP or CRNA program eventually?

If your goal involves the latter (for example), then you may want to seriously consider the bigger place.

Other than those types of considerations, I wouldn't advise being under any illusions that bigger is always better. 

Either way go to the interview and see what happens.