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Fork in the road: Case Mngt vs Acute Care

by danieg315 danieg315 (New) New

So I am currently at a possible fork in the road so I will give you a little background on my experience and tell you my conundrum.

I have been a registered nurse for 3 years now, specializing in Pediatric nursing while working in the home health (one year) and ambulatory primary care clinic (2 years) settings. I have almost 10 years experience in medical offices, home health, and other office, home care and private duty settings within the medical field. I did not get accepted into a residency program for a hospital right out of nursing school so I have no acute care experience and it is near impossible to get it at this point.

However, I had a very good interview with a prominent hospital that I have not heard back about yet for a med/surg unit residency program position.

At this same time, I have already been offered a Clinical Supervisor (Case Management) position with another well known national company.

My problems:

In the acute care setting it will be a 2 year contract in a remote place that is a very isolated part of the US (so relocating 3,000 miles away), working night shift, on an adult med/surg floor.

With the Case management position, I feel I can do the position with my experience but I am concerned that I may pigeon-hole myself if I dive right in or that it will decrease my future options.

My biggest need for advice....

If I get offered the residency, since it seems like a rare opportunity... would it be worth the experience, even if I am not happy with the town/isolation/schedule/pay etc?? It seems as though a lot of jobs want that acute care experience and by passing up this opportunity am I doing my career a disservice? (I still have an anticipated 30 years left)

For case management, the lifestyle would be great and I am confident that I can do the job with my background and skills already. I also know I would enjoy it more, especially right now where I am at in my career... but as a nurse in my later career will this set me back????

Basically, power through 2 years because I will learn a lot and even though my quality of life may go down for a bit, my later self will thank me?

or... take what in the moment seems right because I won't be decreasing my opportunities as much as I am scared of?

Thanks for any seasoned advice... this is such a weird position to be in right now, I really feel like this decision (if I get offered the residency job) will really affect the trajectory of my career. Sorry for the book!!!


Specializes in Cardiac (adult), CC, Peds, MH/Substance. Has 8 years experience.

Depends. What do you want to do long term?

TheCommuter, BSN, RN

Specializes in Case mgmt., rehab, (CRRN), LTC & psych. Has 15 years experience.

The answer to your question depends on your career goals. Do you want or need acute care hospital experience? The manner in which you answer that question should provide some direction on which job to accept.

Personally, I have been a nurse for 11 years. I have no acute care hospital experience and do not intend to obtain any. I work in a lower stress role as a case manager from home for a multinational company. Prior to case management, I was a floor nurse in LTC and acute physical rehabilitation.

On the outside looking in, med/surg seems to entail a great deal of stress, hard work, multi-tasking, direct patient care, and difficult families. To be straight up with you, I want none of these things in a job, so I will stay far away from med/surg. My niche has been found behind the blue light of a computer screen.

SummerGarden, ADN, BSN, MSN, RN

Specializes in ED, ICU, MS/MT, PCU, CM, House Sup, Frontline mgr. Has 13 years experience.

OP: I do not know about "pigeon holed"... because markets fluctuate. If the market tightens it may be harder to move into any specialty to include medical surgical nursing in the future. However, the same can be said of case management. On the other hand, when the market is not tight, nurses can move around with or without the necessary experience needed. With that said, make a choice based on what will make you happy. In other words, do not make a choice based upon fears of future opportunities.

For example, 6 years ago I went into case management with no goal of ever retuning to bedside nursing. When I attempted to move up the nursing career ladder a few years ago I found that Case Management was way too limited at the time and so I looked at the floors. The floors, at the time I applied had so many Assistant Nurse Management positions open I could apply to 5 positions a month in my area, which was not the case when I looked many years earlier. Anyway, the market has tightened again and no one is able to do what I did a few years ago.

On the other hand, entry level case management positions opened in my area three years ago and nurses without experience were able to move into entry level positions in droves. However, this year has been a different story, where employers have gone back to requesting experience for entry level non-managerial positons in case management.

By the way, I work in both fields currently. :) I noticed that it helps to keep my skill set diverse and provides me with more future options (I am working on moving up in my career in the next year or so again).