Long-term care or clinic for new LPN?

[Nurse Beth, MSN]

Congrats on passing the NCLEX-PN! That's a huge accomplishment. And congrats on two job offers! It's great that you're already considering where you can gain the most experience as you begin your career.

Both the long-term care (LTC)/rehabilitation settings, as well as the clinic setting, offer unique benefits. The best choice for you depends on the type of experience you want to gain and your comfort level with the workload and mental demands while you are still in nursing school. Here's a breakdown of both:

Long-Term Care/Rehab Setting

• In LTC and rehab, you'll typically work with older adult populations or patients with chronic conditions, including those recovering from surgeries or injuries. This environment offers the opportunity to develop your foundational nursing skills, including medication administration, wound care, blood sugar management, and patient monitoring, over an extended period.
• You'll also have the opportunity to build your critical thinking in terms of patient care, as you'll often be dealing with a variety of comorbidities and patients with different levels of acuity.

     Challenges

• The workload in long-term care can be pretty demanding, and you may not always have as much direct supervision or interaction with registered nurses (RNs) and doctors. While this environment can feel like a leap into the deep end, it also provides an opportunity to develop independence in your practice.
• LTC often involves higher patient-to-nurse ratios, which can foster independence but may limit real-time mentorship and support.
• Since you're still in nursing school, the responsibilities in LTC/rehab may feel overwhelming at times, especially if you're balancing your studies. However, this setting provides you with a significant amount of hands-on practice in daily patient care.

Clinic Setting

• In a clinic, you'll work with outpatient populations, so you'll be exposed to a variety of patient conditions, but they may not be as complex as in the LTC setting. You can gain hands-on experience with skills such as vital signs, administering injections, performing lab draws, and basic triage.
• Supervision levels vary by setting and by facility. The clinic setting often offers more opportunities to learn from RNs and doctors, as you mentioned. Since you'll likely have a team-based environment, you can observe their interactions with patients and get more guidance as you build your own skills.

    Challenges

• While a clinic may offer more structured learning, the volume of patients can sometimes be fast-paced, if it's a busy facility. If you're trying to balance nursing school, the pace could be overwhelming. However, it might be easier to manage because the workload might not be as intense as in long-term care.
• The clinical skills you gain here may be more narrow compared to the LTC setting (e.g., no tube feedings, foley cath insertions, wound care). Would that concern you?

Which setting is better for learning?

• Clinic setting. If you believe you would benefit from direct supervision and a team-based environment, the clinic setting may be the better option for you. You'll have the opportunity to observe and learn from experienced RNs and providers, and the pace may be more manageable, allowing you to learn without feeling overwhelmed.
• LTC/Rehab Setting. If you feel confident in your ability to work independently and want to develop your critical thinking skills and nursing competencies in a more autonomous setting, then LTC could offer more opportunities to build foundational skills and practice under less supervision.

Recommended approach for a student in school

Since you're still in school, your continued education takes priority.

You mentioned not wanting to be overwhelmed, and it's wise to manage your stress proactively. 

Both settings have their merits, but I would lean toward the clinic setting as less stressful. It's likely to offer more structured learning, less physical strain, and a better opportunity to build your skills and confidence at a manageable pace. Plus, you'll have more exposure to a variety of healthcare professionals, which will enrich your overall learning experience.

And keep in mind that, as your first nursing job, you will learn a lot in either setting. Also, it's not a permanent decision, right? You could always try a few months in the clinic first, with a plan to add LTC exposure if you want broader bedside skills.

I hope this helps you decide!

Best wishes,

Nurse Beth