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Choices - Which Job to Choose?

by Nurse Beth Nurse Beth, MSN (Columnist) Educator Columnist Innovator Expert Nurse

Specializes in Med Surg, Tele, ICU, Ortho. Has 30 years experience.

Dear Nurse Beth,

I am a new graduate nurse and was offered a med-surg position at a private hospital about a month ago. This position requires a two-year commitment. I have already accepted the offer, done with pre-employment process and physical check up. However, I received a phone call from a LA county hospital this week and went to the interview. I got an offer for rehab unit on the same day. I would love to work for LA county but I don't want to break the promise with the other private hospital. What is your advice? Which facility/unit/position is better for a new graduate nurse?

Dear Have Two Offers,

Congrats on graduating and landing a job!

It's ironic that you were offered your job of choice right after you accepted another position. You would not believe how many times I hear this.

There are those who believe that once you accept a job offer, and especially are as far along in the process as you are, the right thing to do is to to honor your commitment. The reasons are

that the facility has reserved a new grad spot for you that could have been awarded to someone else; and that the nursing community is a relatively small one. You don't want to risk burning your bridges.

Others believe that you should do what's best for you. They believe that facilities are businesses and would not hesitate to do what's in their best interest (no loyalty).

But you didn't ask me what is the right thing to do- you asked me whether rehab at county is better than med-surg at a private hospital for a new grad.

Both will give you excellent experience and you are lucky to have two great offers. Med Surg will give you broader experience that will serve you in any specialty you choose at a later time.

While two years may seem like a long time now, it will fly by.

Best wishes in your decision,

Nurse Beth

Author, "Your Last Nursing Class: How to Land Your First Nursing Job"...and your next!


SoCal Nurse

Has 7 years experience.

I would absolutely take the MedSurg job. You'll learn so much (time management, how to interact with the interdisciplinary team, how to read ECG's and what to do about wonky rhythms, wound care, how to work in an RRT/Code, IV starts, foleys, labs, meds, you'll hone that "gut feeling" when you know something isn't right, you'll learn how to communicate with pt's and their family, did I say TIME MANAGEMENT?)

And it doesn't have to be for 2 years. You are not an indentured servant. Start at the bedside, learn how to be a good nurse, then revisit the new and many options you'll have after getting med/surg experience.

I'm not going to tell you which job to take, only you know best. What I will say is from my own experience. I worked in rehab as a new nurse and learned a lot. I worked in a step down neuro floor and learned a lot. I did learn a lot more critical skills on the step down floor, however, going onto it I was already really good at basic skills like Foley insertion and managing NG/peg tubes (I learned a ton of tricks to unclog them ;-)). Additionally, in rehab I learned safe body mechanics and transferring techniques that have probably save my back. The ratios where higher when I worked in rehab since they where not a critical (not always ). I definitely learned a lot of time management skills in both ,but probably more in rehab.

I liked rehab more overall because I got to see how well a patient progressed and I actually saw my nursing interventions work. I loved being able to encourage my patients who thought all hope was lost for a functional life, then seeing them leave rehab stronger. I also became very comfortable in dealing with hospice patients. Often little frail Grandma would come in and wouldn't progress in rehab and regress into further sickness. I became very familiar with the dying process which helps me tremendously where I work now.

I'm currently in the ICU and I love it more than anything! It fits me, but what works for one nurse may make another miserable. No matter which you choose make it work and find the good in the role (even the crappy days and there will be some, especially as a new grad). Either way, you'll learn and grow as a nurse, if you let it.

Edited by Joe V

Dear Have Two Offers, Choosing a new job at any time is hard.

Both Med-Surge and rehab will give you opportunities to hone your skills. Med-Surg will enhance your rapid decision making and observation skills; Rehab will allow you time to know your patients and their families as well as increasing your ability to recognize more subtle signs of problems.

I'm a bit cynical. Why are they requiring you to give them two years? What are they giving you in return? What are the consequences for failing to meet the two year commitment. Some facilities pay your student debts in return for a designated commitment.

The key word in your letter is "pre-employment". You must make your own decision, but you can change your mind mind at anytime until you sign your contract.

riggy3, MSN, RN

Specializes in Surgical ICU, PACU, Educator. Has 30 years experience.

The choice of where to work is ultimately up to you. When I have students ask me similar questions. I encourage time in the medical surgical area first to gain organization and assessment skills strength. Face it the amount of clinical experience you had in school is minimal. When you go to a specialized area as a novice RN my feeling is your experience base gets too narrow. The broader the experience base is then this makes you better prepared for other nursing specialty areas.

The two year commitment is a good idea for the hospital as the cost to orient a new grad is high. Dependent on what source you use the cost is 40,000 to 90,000 dollars to train a new graduate. Cost containment is a big focus in healthcare.

Best wishes for a strong career


Specializes in Med/Surg/. Has 40 years experience.

Everyone has stated all the good reasons for what so I will say do the M/S first as in 2 years LA County will have an opening after that if you want to change over.....