HELP! I can't decide where to work?!

[almostthere1]

I just graduated from nursing school (yay!!). I recently attended a "new nursing grad" open house that a local hospital put on for area students. I made a lot of great contacts and feel like it went pretty well overall. I now feel like I have NO IDEA what I want to do with my life (ha). I have actually applied for several positions, but I'm beginning to get overwhelmed with what to do if I happen to get offered more than one position.

Background: I initially went into nursing school with a very clear cut goal: I wanted to be a midwife. I honestly wanted to nothing to do with med-surg or anything to do with nursing in general, I just needed to go to nursing school to get to the eventual goal of being a certified nurse midwife (I know that sounds strange, but stay with me). As I progressed through nursing school, I soon discovered I LOVED med-surg! Even as I went to different rotations, my instincts would be completely backwards. Thought I would hate OR, LOVE IT. Thought I would hate home care and hospice, LOVE THOSE TOO. Thought I would love OB....hated it? That really threw me off. So I basically now want to work in ALL the units (except OB) at the hospital I'm already employed with (in a clerical position).

Here's my specific dilemma; I have applied for 3 positions within the health system I currently work for. A stepdown unit at a bigger hospital, a medsurg unit at a smaller hospital, and an OR position at a bigger hospital. I'm hoping to take my boards in June. In the unlikely event I were offered two or more of the positions, I have absolutely no idea what I would want to do. The pay would be basically the same for any of the positions, with the exception of the OR position being day shift so I would lose the shift diff the other two would have.

Medsurg at the smaller hospital: I did the majority of my clinical rotations at this hospital. I'm drawn to it because I know the staff/hospital, there are opportunities to receive additional certifications, and many opportunities to cross train/float to other departments like OB, ER, and the outpatient treatment center. However, the hospital is drastically smaller than the larger one, has frequent low census issues, and might not provide as much patient variety as the larger hospital.

Stepdown unit at the larger hospital: I've never done any clinical on this particular unit, I know none of the staff, but I actually work at this hospital currently. I would be getting similar opportunities to receive additional certifications, and would get great experience with higher acuity patients. There are also many pre-/post-op patients on this unit. I feel like the higher acuity patients and pre-/post-op patients would give me good background for the possibility of doing hospice and/or OR later in my career.

OR position: I LOVED my OR clinical rotation, but it was a very small time frame and only observation, so I don't honestly know if I would like being an OR nurse or not. I can say that I applied for an OR transporter position to get my foot in the OR door while I wait for taking my boards. I hope this will give me some insight about whether being an OR nurse is what I want to do. In the event I do love it as much as I think I will, am I shooting myself in the foot for future career path changes if I jump right into a scrub/circulating nurse position? Should I put in some time on med-surg/stepdown to get a good foundation before I specialize?

I apologize for the unorganized nature of this post, but it's late and my brain is still a little zapped from finals. I am honestly so excited to start my career! Any insight or suggestions are much appreciated. I am a very "go with your gut" type of person, but my gut isn't helping me much. I want to take all the positions! ;-)

[Morainey, BSN, RN]

I would work on med-surg. It's a good foundation, and I find it somewhat unlikely that they would hire a new grad directly to step down or the OR, even if you already work in that healthcare system. It's an exciting time. Good luck :)

[almostthere1]

Thank you for your feedback! I did talk to the nurse manager of the step down unit, and she said she LOVES hiring new grads so she can train them her way. I do wonder if anything above medsurg would be overwhelming for me as a new grad though.

[BiotoBSNtoFNP]

If you get offered multiple jobs and are unfamiliar with the unit, ask to shadow! That way you can spend some time interacting w the staff and get a better understanding of what your experience will be like. Obviously you already know what the med surg will be like since you did rotations there. That is a huge plus to that job.

If you really want to be in the OR, take the OR job. But if you are unsure, starting out in the OR MAY (or may not) pigeon hole you in your career.

Med surg and even the step down would be a good foundation to your career. Looks like you have made some great connections in school and have lined up job prospects from these. Other nursing students should take note!! 👍

[Seaofclouds, BSN, RN]

If you are really unsure about the OR, you should definitely see if you can shadow there and get an idea of what being an OR nurse would be like. I think both Med-Surg and Stepdown will give you an opportunity to build your skills and develop a strong foundation for your nursing career. I am guessing that since they are in the same health system, the benefits are all the same, so with that in mind it really comes down to what you want the most and where you feel you fit the best.

[Libby1987]

You sound like someone who will like different experiences in your future career and the OR will not prepare you at all for HH or Hospice. Home Health has been a great career for me but there is just too much to learn with the regulations and ever increasing acuity to come without solid patient care and disease mgmt knowledge and experience.

I would go with the smaller hospital that you already know to shave that layer from the steep learning curve.

[almostthere1]

Thank you for the feedback everyone! I have decided to pursue the smaller hospital medsurg unit. Because I feel myself being pulled in so many different directions as far as specialty interests, it makes the most sense to me to get a good foundation while I explore my options. Also, the smaller hospital is in my hometown, and will be expanding their OR in the next few years. I've talked with the unit manager at length and she informed me the OR at this hospital almost exclusively hires nurses from within the hospital. I sincerely appreciate each of you that took your time to respond to my question. Wish me luck, I have an interview next week! :-)