Job Quandary

[RATMLPN]

Seeking some input, hope this is an OK place for this.

I am an LPN with 10 years of experience including LTC/SNF, home health, inpatient hospice, corrections,  and acute detox (inpatient). I also have 1 year of med/surg, and 2+ years of cardiac stepdown/tele (where I am now).

I graduate in May with my ADN. I have a job in the ICU (literally the unit next to where I am now, where we often transfer patients to or from, depending on what's happening) available to me in July. I can also stay in the unit I am in now.

The caveat? An $8-9/hr pay cut. They're trying to start me at a new grad RN rate, despite my experience in their own hospital. Roughly $14,000/year loss. It would take me 6 years to get back to my current pay rate.

To be clear, there is very little difference between what the RNs can do, and what I can do on the unit I am on. My only limitations are no amio for SVT (which I've only seen once on our unit, and transiently) and the first 15 minutes of a blood transfusion (which I'm present and monitoring regardless). I take the same assignments, the same patients, the same admission diagnoses, etc. I will not be required to go through any novice nurse program after I pass my boards and accept a job (unless I move to the ICU, which all new hires to the unit have to go through for a critical care role). 

My end goal is medflight or CRNA. 

My question is this. Do I take the pay cut, pad my resume, and travel with my experience (and lose benefits, staff I know and who know me). Do I stay and go per diem and take a part time job in another nearby hospital at a higher rate (commute would be a minimum of 30 minutes, up to an hour and ten). Do I go full time with commuting and benefits?

I need 2 years of critical care for CRNA. I need at least one for medalist. I'm in Massachusetts. I'll be going from SEIU to MNA. 

Any thoughts or advice would be appreciated.

[CRNA School Prep Academy]

Hey there, first off — huge congrats on your upcoming ADN graduation! That's such a big step, especially with the incredible experience you already bring to the table. 💪 You're clearly not a "typical" new grad, and I totally hear your frustration about the pay situation — especially when you've already proven your value within the same system.

That said, when you're playing the long game (and it sounds like you absolutely are with CRNA or medflight in your sights), ICU time is gold. If you're serious about CRNA, those 1–2 years of solid critical care are non-negotiable — and the sooner you start clocking that time, the sooner you're eligible to apply.

It's a tough pill to swallow with the pay cut (that's a rant for a different post!), but here's the reframe: look at this ICU role as an investment in your future earning potential. CRNAs easily earn 3x+ what you're making now, and every month of ICU experience gets you closer to that.

You'd also be transitioning into critical care in a unit where you're already familiar with the culture and staff — which could reduce the stress of starting somewhere new.

That said, going per diem on your current unit could be a smart way to soften the financial blow. Keeps a safety net in place, and gives you a little more control over your schedule while you get your footing in the ICU.

Don't forget you're going to need LORs for your CRNA applications, and staying PRN will be helpful for that, too. 

I'd only consider commuting if the ICU experience was truly better elsewhere — think: high acuity, good support, opportunities for leadership etc. Otherwise, you're just trading time for a few extra dollars-- is your time actually worth that extra "income"??

Bottom line: It's not an easy call, but if CRNA is the dream, think in terms of what sets you up best to get there as efficiently as possible. You've clearly got the grit and experience — now it's just about lining up the right steps to get there.

You've got this 🙌

— Jenny


PS- We have a new job board recently launched with high-acuity ICU positions around the country if you want to explore those opportunities! www.jobs.crnaschoolprepacademy.com 

Cheering you on! 

[ChristinaFNP, ASN, BSN, MSN, DNP, APRN]

Congratulations on advancing your career! 

There is a HUGE difference between being a LPN on a stepdown unit and being a RN in ICU. There is actually a huge difference in the roles and responsibilities between LPN and RN overall. I recommend you review your state's NPA to make sure you understand the difference. While it may be a tough pill to swallow, most hospitals are going to "years experience" with the pay model rather than allowing each nurse to negotiate their wages. Even though you have experience as a LPN, you are a new RN. You likely are keeping some of the other benefits that come with longevity such as vacation time. If you are wanting to stay at the hospital where you are, accept the pay and get the experience you are needing for flight nursing and potentially CRNA school down the road. If you are merely looking for the highest bidder, spread your wings and see what bites. Just know it may not be a better situation.