I'm a new grad RN who got her first real nursing job working at a SNF. The SNF I work at is attached to a hospital, which while I was originally not excited to work at a SNF I was excited for the opportunity for advancement into the hospital into one of their med/surg units, etc. Turns out, I really do like working at the SNF. I like my coworkers, the residents, and feel comfortable here. But working at a SNF is not part of my long term goals.
I have worked at the SNF for four months now, so I am just about to get off my probationary "new hire" period soon. Therefore, I wanted to try applying to the hospital and see if I can get a job there, because I feel as if working in Med/Surg would at least get me closer to my ultimate goal of doing something more acute, such as critical care.
But my dilemma is that I feel like I'm disrespecting my employers at the SNF for "jumping ship" basically as soon as I can to work over at the hospital. My ideal situation would be to work at the SNF per diem every other weekend (which is what they originally hired me for, but of course they have me in a 32hr/week position still even with my per diem role). I do feel obligated to them to give them at least a year of my time since they were the first people to believe in me and offer me a job. I don't want anyone to be disappointed or judge me that I would either leave the SNF completely or go down to working there every other weekend.
One last detail: My boyfriend and I do plan to leave the area and move up closer back home where he would have a lot more opportunities to get a job in the field he's about to join. So even if I do apply to the hospital and got a job, I would only stay at the unit for 7 months at most because our lease is up in September and we would move back up closer to our families. So that's another added stress of secretly not even giving the hospital unit a year of my time for being so generous and hiring a new grad onto their unit.
Should I just avoid all this mess and work solely at the SNF for now? Or should I be a little more "selfish" and see if I can get a job that would give me more opportunities to advance to critical care even though I'd secretly only work there for 7 months? I would have to try and find a new job in September despite what I do in this situation because we will 100% be moving away, and I'm not sure if a year's worth of just working at a SNF will give me the best chances at getting a new job rather than working at the SNF *AND* working at the attached hospital for ~7mo would. I could also just apply to a different hospital that's much closer to where I live and tell the SNF that I can't do the commute anymore. But there's still the issue of only giving that hospital 7 months of my time.
This all makes me feel so fake and self absorbed, like I'm not considering what anyone else's feelings or staffing needs are Am I overthinking everything??
Thank you for reading my rambles, I appreciate any input or advice you all have for me.
Can you please break that figure down? Most organizations have nurses fresh off orientation carrying a full patient load, not a half patient load. As for being pulled to support them, that isn't costing the organization extra money. Unless they're calling in extra nurses from home to come in to help a new nurse, then it isn't costing money, because those nurses are there anyway. There's no way that training someone for 8 to 12 weeks costs 36 to 48k. A more accurate figure would be 12 to 15k.
As for your post as it relates to the topic, if you aren't retaining someone like the OP as a satisfied employee, and it keeps happening over and over, your organization is doing something wrong. It's likely not the employee who is "tacky."
I did a casual lit search a few years ago when this question came up and found figures ranging (depending on the source) from $40k to $100k (that's pernewgrad). Another member (UVA Grad Nursing) has posted this in the past:
"According to the American Association of Colleges of Nursing (AACN) and the University Health Consortium, the mean cost of training a new graduate in their first year was $77,000 in 2008. This includes the cost of mentoring (when two nurses are doing one job), classes, reduced workload, etc. The 'break-even' point for most employers is this 24 months."
Granted, it would be quite a bit less in a SNF setting, where they typically offer significantly less orientation and training than in acute care settings.
Can you please break that figure down? Most organizations have nurses fresh off orientation carrying a full patient load, not a half patient load. As for being pulled to support them, that isn't costing the organization extra money. Unless they're calling in extra nurses from home to come in to help a new nurse, then it isn't costing money, because those nurses are there anyway. There's no way that training someone for 8 to 12 weeks costs 36 to 48k. A more accurate figure would be 12 to 15k.
As for your post as it relates to the topic, if you aren't retaining someone like the OP as a satisfied employee, and it keeps happening over and over, your organization is doing something wrong. It's likely not the employee who is "tacky."
Home health.
They start off with more than a week of office and modules at their full hourly rate.
Then for the next few weeks they are strictly shadowing a nurse who is given extra compensation and a reduced caseload to precept.
They eventually start to perform patient care and documentation, still with another nurse preceptor given extra compensation and a reduced caseload for about a month.
Then they start working on their own with 1/3rd to 1/2 case load at hourly rate for the next 2-3 months, still requiring someone pulled off their regular tasks to sit and review work and teach skills as the opportunities arise but not assigning any monetary value, only reduced productivity of that nurse.
At the 5-6 month mark they are seeing the minimum full caseload and supporting their full wage.
Which comes out to $29,532* more or less, in non productive time, a little more than your 12-15K.
Our new nurses start about 90K/year**.
It didn't used to cost this much but newer nurses are requiring more orientation and we try to do a through orientation.
I know of an organization that provides 2 mos of classroom orientation alone. That's over 16K before they hit the field with a preceptor.
* this is straight pay, of course it's costing the employer even more with taxes and benefits.
**We have good retention. See the embedded thread.
I did a casual lit search a few years ago when this question came up and found figures ranging (depending on the source) from $40k to $100k (that's pernewgrad). Another member (UVA Grad Nursing) has posted this in the past:
"According to the American Association of Colleges of Nursing (AACN) and the University Health Consortium, the mean cost of training a new graduate in their first year was $77,000 in 2008. This includes the cost of mentoring (when two nurses are doing one job), classes, reduced workload, etc. The 'break-even' point for most employers is this 24 months."
Granted, it would be quite a bit less in a SNF setting, where they typically offer significantly less orientation and training than in acute care settings.
But that isn't a breakdown of that figure. That's just some arbitrary number they came up with, from the looks of it. I want to know how they came to that number. Or did they opt to not publish their methods? Sounds not legit at all. The biggest expense in training a new nurse is, well, paying them. 77k average to train a new nurse? That's more than a year's salary for a new nurse. So how can paying them for 3 months come even close to that? It's illogical. The classroom training is all figured into that new nurse's weekly hours during orientation so it isn't some "extra" amount that you can add on top of what they are being paid for a 36 or 40 hour work week.
Question: Are these sources counting a new nurse's entire first year, including the 9 months off orientation, as "training?" If so, that's a whole lot of boo-hooray. A new nurse (in an inpatient setting) is carrying a full patient load the day they are off orientation, so to classify that 9 month period of time as purely "training" is flawed. Extremely flawed. A new nurse off orientation is still learning, but they are also working. They are mostly performing independently and utilizing other nurses as resources for advice and unfamiliar procedures. But they are still doing the meat and potatoes of the job (meds, transferring, toileting, admitting, discharging etc) on their own.
Also, if they are counting a preceptor's full hourly wage into the cost to train a new nurse for the orientation period, then that is flawed too because that preceptor and orientee together are still managing a full patient load. They aren't not taking patients. The preceptor isn't being pulled from some other role to take patients for the sake of the orientee, so they are still doing the job of one nurse together. Only the differential they receive can be factored in, which is usually some paltry amount.
To farangoth and libby: I can't speak to home health. I don't doubt that the orientation and costs are different if they are truly orienting people for 5 to 6 months plus. However, that is not even close to the norm in an inpatient setting.
A "nice gesture" to salve one's own conscience, maybe -- it doesn't do anything to change the fact that the individual is screwing over the employer, and the employer and coworkers are not going to be fooled.
As I stated before I agree that she should stick it out til she moves, cause relocating is a good reason to leave a job.. then do this gesture.. Nothing wrong with that.
But that isn't a breakdown of that figure. That's just some arbitrary number they came up with, from the looks of it. I want to know how they came to that number. Or did they opt to not publish their methods? Sounds not legit at all. The biggest expense in training a new nurse is, well, paying them. 77k average to train a new nurse? That's more than a year's salary for a new nurse. So how can paying them for 3 months come even close to that? It's illogical. The classroom training is all figured into that new nurse's weekly hours during orientation so it isn't some "extra" amount that you can add on top of what they are being paid for a 36 or 40 hour work week.
Question: Are these sources counting a new nurse's entire first year, including the 9 months off orientation, as "training" and then classifying entire yearly income as a money sink? If so, that's a whole lot of boo-hooray. A new nurse (in an inpatient setting) is carrying a full patient load the day they are off orientation, so to classify that period of time off orientation as purely "training" is flawed. Extremely flawed. They are mostly performing independently and utilizing other nurses as resources for advice and unfamiliar procedures. But they are still doing the meat and potatoes of the job (meds, transferring, toileting, admitting, discharging etc) on their own.
Also, if they are counting a preceptor's full hourly wage into the cost to train a new nurse for the orientation period, then that is flawed too because that preceptor and orientee together are still managing a full patient load. They aren't not taking patients. The preceptor isn't being pulled from some other role to take patients, so they are still doing the job of one nurse together. Only the differential they receive can be factored in, which is usually some paltry amount.
To farangoth and libby: I can't speak to home health. I don't doubt that the orientation and costs are different if they are truly orienting people for 5 to 6 months plus. However, that is not even close to the norm in an inpatient setting.
The following took about 1 minute to find on the internet, so I did your homework for you:
Many of the published calculations include the cost of "filling the hole" in the schedule created by the person who left. It is actually a calculation of the "cost of a single position turnover" and not just the cost of the education that the new employee receives. When a position turns over, the employer has to pay:
1. A premium of some kind to pay someone to cover the hole in the schedule (overtime pay, per diem premium, traveler, etc.) until a replacement is in position and ready to pull his/her own weight. The person filling the hole almost always makes more than the person who left.
2. The cost of recruiting (maintaining a Recruiting Department -- including their salaries, office space, etc. -- advertising, interview time, computer programs to manage applications and the hiring process, etc.)
3. Immediate "on-boarding" cost. Pre-employment health screening (At my hospital, that alone costs about $500.), the cost of creating computer accounts, establishing automatic payroll accounts, criminal background checks, reference checks, etc., maintaining educators who do hospital-wide orientation, The cost of #2 and #3 alone approach $1,000 per employee.
4. The cost of maintaining an Education Department to provide orientation classes -- not just the salary of the person taking the class -- but paying the educator, maintaining classroom space, computer programs for online education, CPR training materials and registration costs, etc.
5. Premiums offered to preceptors
6. Costs associated with training preceptors (class time, meeting time, etc.)
7. The costs of unit-based educators to oversee orientation
8. Total compensation package of orientee during the time he/she is on orientation -- 1-6 months, depending on job setting. That includes not only the cash salary, but also the costs of benefits, taxes, fees, etc. that hospitals pay. Those "non-salary" expenses are estimated to be 25%-33% of an employee's salary.
Indirect costs - 12% (percentage of overall operating cost of hospital): $10,345
Competency: $96,595
You get an F for your homework.
That might be one of the dumbest things I've read in a while. Most of those are not "costs of hiring a new nurse" as that author disingenuously purports. They're the cost of hiring ANY nurse... nay, any hospital employee. Pre-employment stuff and the electric bill doesn't have anything to do with the cost of hiring a new nurse.
What hospitals ask for lab work from employees??
How does it cost 5000 dollars to do a mandatory review?
How does a physical and lab cost 1000 dollars?
What hospitals have 5 month orientation periods?
Why is a preceptor's salary integrated into the cost of the new nurse's training?
Why would "overall hospital operating costs" factor into this figure?
Who was paying this person to come up with these inflated numbers?
Do what's best for you. Don't worry about offending or hurting feelings. Your employer would screw you over in a second to save a dollar, don't ever believe otherwise. You should worry about you and your future.
That might be one of the dumbest things I've read in a while. Most of those are not "costs of hiring a new nurse" as that author disingenuously purports. They're the cost of hiring ANY nurse... nay, any hospital employee. Pre-employment stuff and the electric bill doesn't have anything to do with the cost of hiring a new nurse.
What hospitals ask for lab work from employees??
How does it cost 5000 dollars to do a mandatory review?
How does a physical and lab cost 1000 dollars?
What hospitals have 5 month orientation periods?
Why is a preceptor's salary integrated into the cost of the new nurse's training?
Why would "overall hospital operating costs" factor into this figure?
Who was paying this person to come up with these inflated numbers?
Can you come up with something based in reality?
Why don't you pull up some numbers yourself and slam 'em down?
Specializes in family practice and school nursing.
Imagine how your prospective employers in the new city will look at your resume. Someone with 4 months of SNF and 7 months of Med/Surg searching for their 3rd job in under a year may rub some HR people the wrong way. Someone with 11 months of steady SNF experience seeking a new job because she's relocating looks better, IMO.
That was a reality that somehow doesn't fit your reality. Figure it out yourself during the next code on your floor.
No, it wasn't close to any reality. That article is TERRIBLE. Seriously, how is a preceptor's medical insurance part of the cost of hiring a new nurse? They would be paying the preceptor benefits even if they DIDN'T hire a new nurse. It isn't as if they hired a preceptor from outside the hospital to orient someone, but that is what the article would have you believe. What is a mandatory review and how does performing one cost $5000?
Since when is labwork part of a pre-employment physical? Who orients nurses for ONE month in the classroom plus FIVE months on the floor? Where do nurse educators spend an hour every single day with an orientee? Nursing education departments do more education and training for existing staff then for new nurses, so why is that cost factored into "hiring a new nurse?" That article is clearly designed to lead people into an anti new nurse mentality. If you think otherwise, you aren't very discerning.
Am I overthinking everything?? 
elkpark
14,633 Posts
I did a casual lit search a few years ago when this question came up and found figures ranging (depending on the source) from $40k to $100k (that's per new grad). Another member (UVA Grad Nursing) has posted this in the past:
"According to the American Association of Colleges of Nursing (AACN) and the University Health Consortium, the mean cost of training a new graduate in their first year was $77,000 in 2008. This includes the cost of mentoring (when two nurses are doing one job), classes, reduced workload, etc. The 'break-even' point for most employers is this 24 months."
Granted, it would be quite a bit less in a SNF setting, where they typically offer significantly less orientation and training than in acute care settings.