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My Reasons For Avoiding The Acute Care Hospital

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Some nurses have never worked one day inside a traditional acute care hospital during the entire length of their nursing careers. How could this possibly happen? While I cannot speak for other nurses, I will provide an answer to the question that multiple people have asked: "Why don't you want to work at a major hospital?"

Specializes in Case mgmt., rehab, (CRRN), LTC & psych. Has 15 years experience.

My Reasons For Avoiding The Acute Care Hospital

I've been asked the same question by members of allnurses.com, real-life coworkers, and even some of my own family members: "Why aren't you interested in working at a major hospital?"

My relatively short nursing career consists of experience in long term care, rehabilitation (acute and sub-acute), and psych. For the past two and a half years I've been employed at a small specialty hospital that provides acute rehabilitation services, and to be honest, I think it's wonderful when a patient discharges to home with the ability to walk and talk when he was bedridden and unable to speak just two weeks ago.

My career is about to traverse into a new chapter when I enter the realm of developmental disabilities nursing starting next week. Twelve years ago, when I was 19 years old, I was employed as a direct care staff member and caregiver at a group home in a residential area that housed six developmentally disabled clients. I mostly enjoyed working with this particular patient population and will be thrilled to finally work as a nurse in this specialty.

Meanwhile, let's venture back to the original question. . .Why do I not want to work at a major hospital? Honest introspection is a major part of my career decision. In addition, my experiences while attending clinical rotations during nursing school at multiple hospitals in two different states cemented my choice to avoid acute care like the plague, especially after seeing how appallingly the nurses were being treated. After much painstaking self-reflection, I realize that an acute care hospital job is not for me. Some people would interject and say, "Well, you'll never know unless you try it!"

To be perfectly blunt, I know my personality is not compatible with acute care. I'm a mellow type B girl who does not like responding to codes. I dislike dealing with changes in condition. I detest taking off orders that constantly change on the whim of the doctor, nurse practitioner, or physician's assistant. I cannot stand constantly performing procedural skills such as IV starts, Foley catheter insertions, nasogastric tube drops, or blood draws. I despise having to drop what I'm doing to address a stat order. I do not look forward to constant interaction with physicians, families, dietary staff, visitors, RT, and other people.

I hate the liability involved with acute care. I do not enjoy the idea of not knowing exactly what I'm going to walk into. I do not like making decisions NOW, and in acute care the nurse must make decisions NOW. Acute care involves a pace with which I'm not comfortable. I'm not an adrenaline junkie. My preferences include low acuity patients, low liability, minimal stress, and the same old routine. I know that several years of acute care hospital experience would be vastly beneficial to my career as a nurse. After all, you don't know what you don't know. However, if I would likely be unhappy during those years, why follow through with it? If I could steer clear of the acute care hospital for the remainder of my career, I'd be content.

Some uninformed people insist that real nursing only takes place inside the walls of the acute care hospital setting. People can think whatever they darn well please. As long as I'm happy, secure, and comfortable with the work I'm doing, that's all that matters to me. Patients outside the hospital setting need nurses, too.

TheCommuter, BSN, RN, CRRN is a longtime physical rehabilitation nurse who has varied experiences upon which to draw for her articles. She was an LPN/LVN for more than four years prior to becoming a Registered Nurse.

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71 Comment(s)

I really enjoyed reading your post. I am a new grad and I have always wanted to be an NP at a women's clinic. I dislike hospitals also. Our personalities seem very similar. I received a job offer at a cataract surgery center and after working a day, I found it was really low stress. I also received a "volunteer" opportunity at an acute care hospital in which I would put in 240 hours of my time to undergo preceptorship and when I'm done, if there are positions available at the hospital and they "like" me, I "might" get hired. I am just thinking about my future and I know that working in a hospital would definitely look good on resume because I could probably land a job anywhere. I would also be making almost double what I'll be making if I worked at an ASC. What is causing my dilemma is that I dont know if I could take the "chance" of getting hired, especially if I have a job offer right now. I don't even want to work in a hospital, so why would I take a chance of being slave and then not get hired. If I could please have your advice and opinion I'd appreciate it!

TheCommuter, BSN, RN

Specializes in Case mgmt., rehab, (CRRN), LTC & psych. Has 15 years experience.

If I could please have your advice and opinion I'd appreciate it!
Many nursing educators and experienced nurses will urge you to accumulate that golden year or two of experience at the exalted acute care hospital because it will open doors in your career due to the amazing foundation that it provides.

However, if you envision yourself being happy at the cataract surgery center and have a firm job offer there, I would go for it. Many nurses would kill for the chance to work daylight hours in a low-stress setting. Sometimes you must take the path less worn. In addition, there's no guarantee of any firm job offer at the hospital once your free 240 hour unpaid preceptorship is completed.

It would be nice if others would chime in with their advice on your situation. Good luck with whatever you decide.

gonzo1, ASN, RN

Specializes in ED, ICU, PSYCH, PP, CEN. Has 18 years experience.

Commuter-I so respect you. I do ER and ICU and before that I did physical therapy. I did go for the hospital job. But, you are right, it is not the only avenue. You touched on every hot spot of why most nurses hate the hospital. And most of us that work there are simply hostages to the higher pay.

It is refreshing to have someone, after careful review, decide to take the non-traditional route. You are absolutely right, nurses are needed all over. Not just in hospitals. The patients/clients you are going to be working with are very lucky to be getting you. Best of wishes to you in your new adventure.

brandy1017, ASN, RN

Specializes in Critical Care.

Sounds like you are making the right choice for you! Congrats! Many of us working in the hospital system have the same feelings and personalities but struggle on anyway and end up depressed, anxious or having a nervous breakdown! Plus all you've said is true, working conditions are grim and getting grimmer at many places. There is nothing wrong with not going the hospital route and you'll probably have a happier, saner, better life! The nurses I know who quit the hospital never came back.

I miss the job I used to have before I became a nurse, I never knew how good I had it, unfortunately it did not pay a living wage. Why are there so few jobs in America these days that pay a living wage? But I resent the constant cutbacks and nickling and diming of benefits and working conditions in the health system and can't wait till I can afford to retire and get the heck out of dodge! At least working 3 12 hour shifts makes it more bearable, the worse thing is I fear how much worse things are going to get before I can retire! I don't see working conditions getting better only worse as the hospitals and nursing homes and healthcare etc keep cutting costs in this messed up healthcare system that is America!

Edited by brandy1017

imintrouble, BSN, RN

Specializes in LTC Rehab Med/Surg. Has 16 years experience.

I think Commuter and I were twins separated at birth. Only she got all the smarts.

You could be describing me and my nursing career. I've actually said to my co-workers what you've written in your post.

You just have to know yourself well enough to resist those who try to persuade you the only "real" nurses work in hospitals. The "best" nurses work in SCU or ER. Those who work in LTC only work there because they couldn't get a job any place else.

The best thing about nursing, is there's a place for all of us.

DaniannaRN

Specializes in Quality Control,Long Term Care, Psych, UM, CM. Has 13 years experience.

THANK YOU!!! These are my thoughts exactly. You perfectly described every single reason why I hated working in a hospital for 3 months, and why I would never EVER do it again.

You're right, real nurses aren't confined to a hospital. I'm a real nurse too, I help people in a different way.

And to nemobear, take the cataract center job. I'm pretty sure the hospital will let you volunteer then claim there is no job for you at the end.

smurfynursey

Specializes in peds palliative care and hospice.

imintrouble and The Commuter...perhaps we were siblings separated at birth! I think I am younger than both of you but I feel the same way!

Cheers!

Nascar nurse, ASN, RN

Specializes in LTC & Hospice. Has 35 years experience.

After being an LPN for 19 years I finally got my RN in 2005. Couldn't wait to get out of LTC and on to a "real" nursing job at the hospital. Applied to local hospital, got the interview and got the job. Went home, thought about this for about 24 hours and came to the conclusion "What the hell am I doing this for? To please others or to please myself"? Decided I love my little old people and they seem to love me and by gosh, I'm darn good at this job both in my heart and clinically.

I called the hospital back and declined the job. No regrets.

NurseCard, ADN

Specializes in Med/Surge, Psych, LTC, Home Health. Has 13 years experience.

Commuter, I think you and I are soul sisters. I TOTALLY could have written that. I too am very Type B, hate dealing with doctors, hate dealing with new people all the time, hate dealing with family members, and like knowing what I'm going to walk into. Now, I don't mind a little bit of an adrenaline rush every now and then, but not from being in the middle of a code blue; I prefer a good roller coaster. =)

I've found that long term care and psych both, fit my personality SO much better than acute care and so I also avoid big hospitals. I'm finding however, that I'm really growing tired of the stringent regulations and harsh realities of long term care nursing, so I'm getting good and ready to go back to psych.

I am glad you shared this. You sound a lot like me actually, but you really stuck to your personal beliefs and preferences...you stayed genuine with who you are and did not falter despite what other people may have thought, especially when you stated,

Some uninformed people insist that real nursing only takes place inside the walls of the acute care hospital setting.
I admit that I fell for this false belief and that's why I'm still working in an acute setting and miserable! I tried to convince myself that working at a more prestigious hospital is what I want, but it's not. Unlike you, I haven't really contemplated what I want and actually stick to it and stay genuine. I get too caught up in what other people think of me--parents, friends, other nurse colleagues--if I were to leave the acute care setting and "settle" for something not fast paced or a hospital with a big name.

I'm going to really take an introspective look at my own personality and beliefs in order to feel content and happy with my work because frankly, I have a hard time leaving work at work. I think if I don't make a change it'll just continue to bleed into my personal life and I can't have it affecting my patient care either.

Thank you for sharing.

This is a very helpful and reassuring article. You named all the things I fear about a hospital job. Thank you for reminding me that nursing =/= hospital.

I wonder if part of the reason people are so adamant about new nurses needing to start out in med/surg and get that golden year of experience is because it's what they did...and what everyone told them to do...and what their professors had to do...etc, etc. I'm not saying it's always the case, because I'm sure there are people who chose to take the med/surg route when they had the opportunity to go straight into their specialty, but I think some people start out in med/surg because it's the only option available. So, instead of saying, "I couldn't get a job as a new grad in the specialty I want," they say, "I really wanted to start out in med/surg and get some experience."

I struggled with whether or not I should start out in med/surg even though I really wanted to do psych. I KNEW I wanted to do psych and that I would hate med/surg because I worked med/surg as an intern. Still, I had so many people say, "You should really get a year in med/surg as an RN," that it made me question my choices.

Ultimately, I chose to go with the job I've always wanted. I was talking to a nurse who works in psych about this very thing before I decided and she said, "I can't imagine getting paid what I get paid here (at the psych facility) to work on med/surg." I agreed. I worked on med/surg before, even though the role was different, I knew it would be almost constant high stress, very physically demanding, and I remember so many nurses saying, "I feel like my license is always on the line."

Who knows. Maybe one day I'll regret not getting that golden year of med/surg experience, but right now I highly doubt it. I don't think any nursing job is totally stress free, but mine is pretty laid back. I live in one of the lowest paid areas in the country and I don't feel as over worked and underpaid as many of my peers do. I dunno if I like my job because it's low stress, or if it's low stress because I like my job. Either way, I'm certain if I would've stayed in med/surg or anything like it (which was my plan as an intern) I would be completely miserable and burned out.

Multicollinearity, BSN, RN

Specializes in Acute Care Psych, DNP Student. Has 4 years experience.

To be perfectly blunt, I know my personality is not compatible with acute care. I’m a mellow type B girl who does not like responding to codes. I dislike dealing with changes in condition. I detest taking off orders that constantly change on the whim of the doctor, nurse practitioner, or physician‘s assistant. I cannot stand constantly performing procedural skills such as IV starts, Foley catheter insertions, nasogastric tube drops, or blood draws. I despise having to drop what I'm doing to address a stat order. I do not look forward to constant interaction with physicians, families, dietary staff, visitors, RT, and other people.

Some uninformed people insist that real nursing only takes place inside the walls of the acute care hospital setting. People can think whatever they darn well please. As long as I’m happy, secure, and comfortable with the work I’m doing, that’s all that matters to me. Patients outside the hospital setting need nurses, too.

What's interesting to me is the variation of practice within different nursing environments.

When I graduated from nursing school I consciously rejected acute care employment for many of the reasons you listed. I took a job at a correctional facility and found myself doing all of what you listed above - but without the backup a hospital provides. Many of our nurses at the prison went to the local hospital because they said the pace was too much at the prison. They liked med/surg at the local hospital because they said the pace of work was better. A couple joked they could "rest" in med/surg compared to our prison jobs.

Now I work acute care psych and find this hospital job is nothing compared to my previous non-hospital job.

I really don't care about uniformed nurses who think real nursing takes place inside a hospital - their narrow scopes and perceptions don't concern me.

OnlybyHisgraceRN, ASN, RN

Specializes in LTC and School Health.

Commuter- You have done it again.... Put my feelings into an article. I was told to start off in a hospital because "that is the right thing to do" as a new grad. Even though I had previous LPN experience prior to becoming a RN, I had a really hard time adjusting to the hosptial setting.

Stat orders, codes, critical labs, call lights, all memebers of the disciplinary team, rounding, and etc. It was overwhelming. I think I'm a mixture of A and B personality, mostly b though.

During my time in ICU, I thought this was just normal new grad blues but I was wrong. Working in ICU nearly drove me into an early grave. I was drinking wine almost 3-4 times a week, taking ativan, and just really really depressed. Ofcourse my co-workers didn't help with creating a hostile environment. I came to the realization that this specialty and type of nursing is NOT for me and doesn't fit my personality.

To test my theory, I interviewed and shawdowed at another ICU and felt the same way.

I typically like a routine with an occassional code to keep me on my toes. In ICU, I felt like I was putting out fires all day long. I have an offer pending for the ER, my husband tells me I shouldn't take the job because he knows my personality does not fit one of the ER. I agree with him, however I need a job.

I'm praying I get into PP or NBN. I think I would be excel in that area.

OnlybyHisgraceRN, ASN, RN

Specializes in LTC and School Health.

I'm tired of ER,ICU nurses thanking they are God. I used to hear my ICU co-workers put down every single specialty in the hospital. I would get so offended. Specialities are not a one size fits all. Everyone has their own unique gifts and talents that contributes to every area of nursing.

I'm tired of ER,ICU nurses thanking they are God. I used to hear my ICU co-workers put down every single specialty in the hospital. I would get so offended. Specialities are not a one size fits all. Everyone has their own unique gifts and talents that contributes to every area of nursing.

That's so weird. I don't get it. There are a few specialties I would never, ever want to work in but I really don't think about them at all...much less put down the people who work in them. That's just...odd.

That's so weird. I don't get it. There are a few specialties I would never, ever want to work in but I really don't think about them at all...much less put down the people who work in them. That's just...odd.

I don't understand, either. I know there are many specialties/settings in which I wouldn't want to work simply because I know I would not be a good fit.

I think every nurse has a specific calling. For example, one of my nursing friends says that she couldn't handle the ED, while I state I couldn't handle rehab nursing. But I believe we are where we both need to be to be the best nurses we can be. It is too bad that acute care seems to be glorified, but I really am grateful for all of you nurses who do the less "notorious" specialties. Nursing is an art and a science across the board, no matter where you practice or who receives your care.