Career Advice for a New Grad

[burk0282]

I am a new graduate nurse whose ultimate goal is to go into critical care nursing. Currently, I have only my RN licensure and will be continuing to take classes for the next 18 months to finish my BSN, and am looking for some guidance on what you guys have seen best prepare nurses to *eventually* be successful and competent ICU nurses!

I feel lucky that I have had quite a few job offers despite being a new grad, but most hospitals here in MN will only hire BSNs, so I wasn't able to get a med-surg position that had any regularity in schedule (float, on call, flexible hours) that just wouldn't work with me still being a student. I know no one can tell me what I 'should' do without having a crystal ball, but these are the two very different offers I am considering, and would love your input on what you seasoned CCNs think would be the most beneficial:

1. A position where I would be working at a skilled nursing long-term care facility, with an overwhelming resident population suffering from dementia from August until February, cross train me in their TCU, and then move me to have my own "wing" at a brand new TCU facility literally connected to the hospital I would eventually like to work at. I feel getting my foot in the door with the company is a smart move, but the position would be considerably more stressful, and I am having a hard time swallowing the time spent in LTC, since my passion is more "medical" than "nurturing" if that makes sense?

2. A position at an ambulatory surgery center (ophthalmology, so nothing to extreme- lots of cataracts!) doing pre-op, post-op, IVs, conscious sedation, and the possibility to work a circulating nurse role. This position pays a LOT more than the LTC/TCU position, but is not affiliated with any hospital systems, and would probably not give me the same scope of "direct patient care" experience the other position would as it is an ambulatory clinic.

THANK YOU in advance for any insights or recommendations on what paths you have seen others (or yourselves) take to get into critical care and be awesome at it. I appreciate any thoughts!!

[dishes, BSN, RN]

You should re-think that med-surg position, even though it is irregular hours, it will provide a more comprehensive experience and exposure to a broader patient population.

[NurseGirl525, ASN, RN]

Where in MN are you? I know for a fact Mayo Clinic hires ASNs. They actually pay for moving expenses as well.

You say you only have your RN licensure. You will still have the same license as a BSN. RN is a license. The ASN and BSN are the degree. They are though the same nurse. The clinical hour component is the same amount. Does that make sense?

You don't need a BSN to get into critical care. I'm a new grad with an ASN in a specialized critical care unit. I'm also an RN.

[bsnprg]

I am not sure how much experience do you have with patient care, but in my case I never worked in a medical facility except being a receptionist in a small private psych clinic for a few weeks and volunteer hours . After graduation I knew that I wasn't ready for an acute care setting even if I had gotten an offer. I got a job at a wonderful LTC with pretty much the same opportunities you described; a chance to work at a TCU and then be competent enough to move on to one of their larger acute care settings .

I never really wanted to work at a LTC as a new grad pretty much due to the same reasons that you have described , but it surprisingly was a great place to get the experience one needs to choose the right field in nursing.

There are definitely some cons to every department, but that can also vary based on the facility.

Try your best to review your nursing materials and best practices in nursing even if your are extremely busy and try not to let bad habits or short cuts become part of your daily nursing care. It is really difficult to supervise your aids when you are new . try your your best to be consistent and maintain that relationship. Even though they know a lot about patient care and their patient cater plan , they dent know how busy you are and what your job entails . Most acute care settings prefer a much structured work environment and focus a lot more on infection control . I personally felt that it was a lot more difficult for me to retain nursing practice at high standard mainly because of pure exhastion and trying my best to provide safe nursing care. Any ways be close to your supervisor, work hard, try to maintain a good relationship with everyone and know yiue patients. Good luck and please LMK if you have any specific questions that I can answer .

[bsnprg]

Did any one go on to acute care setting after working at a LTC facility?

What were your experiences ? Anybword of advise?

[burk0282]

Thanks for your input. I am certain I will work in a med-surg unit for those exact reasons in the future, and I wish a better offer would have been made. Unfortunately though, I had bills that I could not afford to "hope" I got enough hours to actually pay!

[dishes, BSN, RN]

Thanks for your input. I am certain I will work in a med-surg unit for those exact reasons in the future, and I wish a better offer would have been made. Unfortunately though, I had bills that I could not afford to "hope" I got enough hours to actually pay!

I understand about taking the financially safer route, but if you look at the big picture you need the experience that will lead to your career goal. Sometimes trusting that things will work out and taking a chance by accepting a casual position in a workplace that gives relevant experience is the better way to go.

[Been there,done that, ASN, RN]

The dementia wing in LTC would be Hades on earth for any nurse, let alone a new grad. Fail to see what skills you would obtain that would make you more desirable in critical care.

IV's, administration of conscious sedation, and monitoring and teaching those patients.. will be very valuable in critical care. " This position pays a LOT more". Good! Money is the reason we all work.

Speaking of Hades on Earth... stay away from the MAYO.

[Zelda, RN]

My rule of thumb is to take every position at face value. That means that even if they SAY they will be cross training you, they may not follow through. Assume you would be in the LTC building forever if you took that position. There is a chance they'd do exactly as they said, but there is also a chance they wouldn't.

[dishes, BSN, RN]

I think there is a high chance the LTC is using bait and switch tactics by giving an empty promise that there will be a better opportunity in the future, bet they didn't give that promise in writing.

[TheCommuter, BSN, RN]

Moved to the First Year After Nursing Licensure forum.

[burk0282]

dishes, you were 110% right. I DID end up going with the LTC/TCU position, and within 2 weeks it ended up becoming very clear that they were stringing me along and kept delaying putting the conditions of my hire in writing, and taking days and multiple phone calls to answer questions and concerns. Sad, but your gut was right on this one! Thanks!