Job Decisions as a New Grad Nurse

[NewGradNurse3, BSN, RN]

Hi, I'm a fresh new graduate living in Chicago, still waiting for my ATT for my NCLEX, so probably won't be licensed til sometime in July. Seeking some career/job advice.

I was working as a VALOR intern for the past year at the VA hospital on a medsurg floor. It was overall a great way to get hands on experience - I got the opportunity to practice both RN and CNA skills, and got pretty comfortable with charting, meds, IV fluids/meds, GI tubes, CBIs, EKGs, overall workflow. Things I didn't get experience with (but wished I had) - I hardly ever saw trachs, only inserted a foley once, never successfully inserted an IV (but got to try a few times). Still, I definitely got way more experience than I got in my clinicals.

I'm feeling conflicted about whether to just stay at the VA or find a job at another hospital. Some reasons I didn't want to stay at the VA were: I know that the way they teach us to do things in nursing school is not real life, but some of the things I saw I didn't really feel comfortable with - I saw nurses do things like document lower pain scores than patients reported, and when I asked questions about things I saw in a patient's chart or condition, I sometimes felt like the nurses didn't seem to really know the answer or were just guessing. I know that on a medsurg unit, you can't go chasing every little thing or know everything about your patients, but I feel like as a new grad I'd prefer to really be able to understand what's going on with my patient (but I admit that that's hard when you have 5-6 patients). A lot of the patients on my unit were nursing home/long term care patients cycling between the NH and hospital, and it seemed like there was a lot of burnout and apathy around caring for these patients. I've heard some staff say that the culture at that VA isn't good. I talked to a new grad nurse on the unit who said she had to get a part time job at another hospital to feel like she was really learning her nursing skills properly - the nurses on my unit rarely inserted IVs (because on day shift you can call the phlebotomist to do it), and hospital policy was that MDs would do things like insert NG tubes or remove PICC lines, not RNs, so I never learned/observed those skills. Overall, it seems like the patients at the VA are generally lower acuity than at a regular hospital, and the coordinator of the internship actually said that the ER at our hospital is more like an urgent care and the ICU is more like a stepdown unit. On my medsurg unit it was a lot of routine care, passing meds and charting, but didn't feel like there was much critical thinking involved.

As a new grad my biggest goal is to work where I'm going to learn the most. My fear is that if I stay at the VA, I won't really learn as much as if I go to a regular hospital. Aside from acuity, the vast majority of VA patients are also male, so I'm going to miss out on learning anything about women's health or even basic things like practicing inserting foleys on a female. I'm interested in working in critical care settings like the ICU and/or ER eventually, and so I really want to feel like I'm learning everything I can as a new grad and know my stuff.

However, the pros are that I'm pretty much guaranteed a job there, I'm already familiar with how the hospital works so it would make orientation go a lot smoother, and I think I'm more likely to be able to be hired onto a critical care unit like an ICU as a new grad. They already hired one of the other interns to the ICU, and when I asked the coordinator of the program about it she said that I should feel free to apply and seemed to think it was possible especially as a VALOR student to get hired onto the ICU as a new grad. Whereas, I think it's unlikely that I'd be hired onto an ICU as a new grad at any other hospital, since I don't have any ICU experience as a CNA or anything.

My plan is to just try applying around and see what I'm able to get into, but if your goal was to learn as much as possible as a new grad, do you think it would be better for me to try to get a job in the ICU or ER at the VA, or to start as a medsurg nurse at a hospital where I'm going to see a wider variety and higher acuity of cases, and where maybe the culture is more condusive to learning?

[Been there,done that, ASN, RN]

You will have plenty of opportunities to learn in the VA. Research the difference in benefits between the VA and any other facility.

I know disability / retirement is not on your radar... but the VA has fantastic. benefits.

Best wishes wherever you land.

[ajnurse2b6]

Hi, being a new graduate nurse is such an exciting and scary time. Especially right now in the time of covid, there is a lot of uncertainty. First things first, focus on studying and passing NCLEX. Next, whatever decision you make it will be a learning experience for you and no job is permanent. The great thing about the nursing career is that you will have opportunities to try different specialties.

Next, apply to jobs at many different hospitals in the Chicagoland area! Make sure to emphasize your experience at the VA, the skills you learned, how you practiced many important nursing skills, and how it will ease the transition into the RN role. You said that your plan is to apply and see what you get into. That's a great plan. Stay organized and stay positive.

If your goal is to learn as much as possible as a new grad, it would probably be best for you to get a medsurg job at a hospital with higher acuity or get a job in an ICU or stepdown floor at the VA like you said. Keep in mind that the most important factor for a positive learning environment are your coworkers and management. Find a floor where the nurses and nice and supportive and management is understanding of the educational needs of new grads. Good luck!

[LibraNurse27, BSN, RN]

1 hour ago, ajnurse2b6 said:

Hi, being a new graduate nurse is such an exciting and scary time. Especially right now in the time of covid, there is a lot of uncertainty. First things first, focus on studying and passing NCLEX. Next, whatever decision you make it will be a learning experience for you and no job is permanent. The great thing about the nursing career is that you will have opportunities to try different specialties.

Next, apply to jobs at many different hospitals in the Chicagoland area! Make sure to emphasize your experience at the VA, the skills you learned, how you practiced many important nursing skills, and how it will ease the transition into the RN role. You said that your plan is to apply and see what you get into. That's a great plan. Stay organized and stay positive.

If your goal is to learn as much as possible as a new grad, it would probably be best for you to get a medsurg job at a hospital with higher acuity or get a job in an ICU or stepdown floor at the VA like you said. Keep in mind that the most important factor for a positive learning environment are your coworkers and management. Find a floor where the nurses and nice and supportive and management is understanding of the educational needs of new grads. Good luck!

I agree, a huge part of making your time as a new grad a positive experience is the people you work with/ unit culture. Finding a place where the nurses and management are supportive is even more important than the type of unit in my opinion. As a new grad you can learn new things in any specialty, and transfer when you have your basic skills down. Being in an environment conducive to learning will help you succeed. And I agree that benefits are something to consider. Since it's hard to find a job during covid it's great that you have some sort of in at the VA. Good luck with your NCLEX and your first job, you sound excited and motivated!