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How to transition from skilled nursing to acute care

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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 read your book in one sitting when I met you here online..such an AWESOME book. I highly recommend it for students and working nurses. With TONS of golden nuggets and gems.

Thank you for your advice on my previous question 2-3yrs ago...After our conversation, I went to my homeland and worked in the Acute Hospital for 6 months. I worked in MS and after getting adjusted for 2 months I crossed trained in the Emergency Dept and worked in both departments and finished my 6 months. When I came back to the US I landed a job in a Skilled Nursing Facility thereafter. Now...I will hit my 1 year this 2021 as a full-time day shift Nurse and want to level up my career. What advice would you give me to land a job in an Acute Hospital to be able to work in MS or ER or ICU? Thank you so much for your time and I appreciate your advice. I would be glad to hear from you again.

Dear Wants to Level Up,

Thank you for your kind words, and I'm so glad my book helped you.

It can be challenging to land your first job in acute care and the short answer as to how is persistence.

The challenge is that many acute care employers will not count your out of country nursing experience as RN experience. They will accord you the same experience as a new grad (no acute care experience) but often without accompanying new grad status.

By that I mean you may not qualify for an RN residency program. That's not a hard and fast rule, as each hospital sets its own eligibility criteria. Some (most) hire new grads who graduated within the last year and have not had acute care experience. Some bend the rules for nurses such as yourself who graduated more than a year ago but have no US acute care experience. You have nothing to lose by applying- but you need to have thick skin. 

A new grad residency is not the only way to get in. You do have 1 year sub-acute experience, and many nurses like yourself transition from skilled nursing to acute care given the opportunity.

What you also have going for you is determination, apparent from your accomplishments thus far. This is a good predictor. You will need to apply and apply as much as it takes. Be willing to relocate, if able. Activate your network and let everyone know you are looking for a job. Be willing to work in any specialty that is hiring to get your foot in the door.

Read in my book on how to compose your resume in order to stand out, and be sure and read how to do a cold-call, as again, you have nothing to lose. 

Best wishes,

Nurse Beth


Specializes in Long term care; med-surg; critical care. Has 9 years experience.

I agree that making the transition from long term/skilled nursing to acute care can be a challenge. I think that, fortunately, more and more hospitals view nurses from long term care as a valuable resource with a solid skill set. There are more hospitals in my area willing to help nurses transition from LTC to acute care, not through the more traditional new grad programs, but with sort of a hybrid orientation- not a new nurse, but more orientation than a nurse transitioning from another acute care position.

The hardest part, as always, is getting a foot in the door. Do you have any coworkers or former coworkers that have found acute care positions? You might even consider cold calling some local hospitals and speaking with someone in their nursing or nursing education office about  your situation. The one upside to the COVID crisis is that many acute care facilities are scrambling to find adequate help and are looking for ways to attract talent. Good luck!


Specializes in Vents, Telemetry, Home Care, Home infusion. Has 44 years experience.

Many hospitals have "Transitional Care Units = TCU"  which function as a  short term SNF while awaiting patient placement in LTC facility, transfer to Rehab unit or discharge home.   This would get your foot in the door of a hospital with opportunity to transfer to acute later , especially if  good work ethic and Management doesn't want to loose you to a competitor.

Best wishes in your nursing journey.